ADA request for accmodations (2)

docx

School

University of Toledo *

*We aren’t endorsed by this school

Course

2700

Subject

Mechanical Engineering

Date

Dec 6, 2023

Type

docx

Pages

3

Uploaded by MegaSnowGoldfinch31

Report
Req u es t fo r Acco mm oda t io n s un de r t h e P A R T I A m e r ica n s w i t h Disabili t ies Ac t ( A D A ) 1 . F i r st Na me : Mariam M I : F Last Na me : Shaheen 2 . Add r e ss : 4 9 0 9 T a m w o r t h R d C i ty : Sylvania Stat e : Ohio Z i p Cod e : 4 3 5 6 0 Co un t r y : U . S . A . A H I M A I D : 2881376 3 . Fo r w h i c h of t h e fo ll ow i n g e xa m s a r e yo u r e q u e st i n g acco mm odat i o n s ? C C A C C S CC S - P RH I A X RH I T C H P S C H DA CD I P 4 . Nat u r e of yo u r d i sab ili ty : H e a r i n g V i s u a l P h ys i ca l X L e a r n i n g Psyc h i at r i c Ot h e r , p l e as e sp e c i fy ______________________________________________ 5 . How l o n g ago was yo u r d i sab ili ty d i ag n os e d ? L e ss t h a n 1 y e a r 1 2 y e a r s 2 5 y e a r s X Ov e r 5 y e a r s 6 . I n o r d e r to f u ll y doc u me n t yo u r n ee d fo r acco mm odat i o n s , p l e as e i n c l u d e a b r i e f p e r so n a l stat eme n t d e sc r i b i n g yo u r d i sab ili ty a n d i ts i m pact o n yo u r da il y li f e a n d e d u cat i o n a l f un ct i o n i n g . I have a severe learning disability since I started preschool. I need longer time to comprehend and process information. My learning disability impacts my daily life I can’t drive till now. I need support on a daily basis. My learning disability has negative impact on my education as well it took me seven years to finish my associate degree and held me back from starting my career and be independent. 7 . Hav e yo u p r e v i o u s l y r e c e i v e d acco mm odat i o n s i n a n y e d u cat i o n a l o r t e st i n g s i t u at i o n ? X Y e s No I f y e s , p l e as e d e sc r i b e t h e acco mm odat i o n s r e c e i v e d . Double time on tests, separate testing room, reader, calculator 8 . W h i c h of t h e fo ll ow i n g acco mm odat i o n s a r e yo u r e q u e st i n g ? X S e pa r at e t e st i n g r oo m X Ext e n d e d t e st i n g t i me Sc r ee n m ag n i f i e r /zoo m t e c hn o l ogy X R e ad e r Ot h e r , p l e as e sp e c i fy ______________________________ I c e r t i fy t h at t h e i n fo r m at i o n p r ov i d e d abov e i s t r u e a n d acc u r at e . S i g n at u r e : Mariam Shaheen Dat e : 1 2 / 1 5 / 2 0 2 2 P l e a se s c a n t he c o m p l e t ed a pp l i c a t i o n a n d o ff i c i a l 1 d o c u m e nt a t i o n t o : c e r t i f i c a t i o n @ a h i m a . o r g X
I n fo r m a t io n t o be p r ovided by a q u ali f ied h eal t h p r ofessio n al , P A R T II a n d a tt ac h ed t o Pa r t I of t h e A DA applica t io n . Doc u me n tat i o n of d i sab ili ty ass i sts AH I M A i n d e t e r m i n i n g r e aso n ab l e acco mm odat i o n s un d e r t h e A me r i ca n s w i t h D i sab ili t i e s Act , w h i c h a r e d e t e r m i n e d o n a cas e -by-cas e bas i s . I f t h e s u b m i tt e d doc u me n tat i o n i s i n co m p l e t e o r do e s n ot s u ppo r t t h e r e q u e st , t h e app li ca n t w ill b e ask e d to p r ov i d e add i t i o n a l doc u me n tat i o n . T h e cost of obta i n i n g a ll doc u me n tat i o n i s bo r n e by t h e app li ca n t . T h e doc u me n tat i o n s u b m i tt e d s h o u l d b e as co m p r e h e n s i v e as poss i b l e i n o r d e r to a ll ow AH I M A to m ak e a n i n fo r me d d e c i s i o n o n t h e acco mm odat i o n r e q u e st a n d to avo i d d e l ays i n t h e d e c i s i o n - m ak i n g p r oc e ss . Doc u me n tat i o n , a l o n g w i t h t h e AH I M A T e st Acco mm odat i o n R e q u e st Fo r m s h o u l d b e s u b m i tt e d to AH I M A e a r l y e n o u g h to a ll ow s u fic i e n t t i me to r e v i e w t h e r e q u e st a n d i m p l eme n t r e aso n ab l e acco mm odat i o n s a n d/o r s e r v i c e s w i t h i n r e g i st r at i o n d e ad li n e s . Doc u me n tat i o n m u st b e p r ov i d e d by a li c e n s e d o r ot h e r w i s e p r op e r l y c r e d e n t i a l e d p r of e ss i o n a l w h o h as un d e r go n e app r op r i at e a n d co m p r e h e n s i v e t r a i n i n g , h as r e l e va n t e xp e r i e n c e , a n d h as n o fa m ili a l r e l at i o n s h i p w i t h t h e i n d i v i d u a l b e i n g e va l u at e d . T h e i n d i v i d u a l m ak i n g t h e d i ag n os i s m u st b e q u a li f i e d to do so (fo r e xa m p l e , a n o r t h op e d i c li m i tat i o n m i g h t b e doc u me n t e d by a p h ys i c i a n , b u t n ot a li c e n s e d psyc h o l og i st) . Doc u me n tat i o n s h o u l d b e typ e d o r p r i n t e d o n ofic i a l l e tt e r h e ad w i t h t h e n a me , t i t l e , p r of e ss i o n a l c r e d e n t i a l s , add r e ss , p h o n e nu m b e r , a n d s i g n at u r e of t h e e va l u ato r , as w e ll as t h e dat e of t h e r e po r t . T h e doc um e n t a t io n s h o u ld be c u rr e n t . B e ca u s e t h e p r ov i s i o n of r e aso n ab l e acco mm odat i o n s i s bas e d o n ass e ss me n t of t h e c u rr e n t i m pact of t h e app li ca n t s d i sab ili ty o n t h e t e st i n g act i v i ty , i t i s i n t h e i n d i v i d u a l s b e st i n t e r e st to p r ov i d e r e c e n t doc u me n tat i o n . A s t h e m a n i f e stat i o n s of a d i sab ili ty m ay va r y ov e r t i me a n d i n d i ff e r e n t s e t i n gs , i n m ost cas e s a n e va l u at i o n s h o u l d h av e b ee n co n d u ct e d w i t h i n t h e past t h r ee y e a r s . C e r ta i n co n d i t i o n s s u c h as so me p h ys i ca l a n d psyc h i at r i c co n d i t i o n s a r e s u b j e ct to c h a n g e a n d s h o u l d b e u pdat e d fo r c u rr e n t f un ct i o n i n g . P l e a s e s c a n t h e c o m p l e t e d a pp l i c a t i on a n d o ff i c i a l d o c u m e n t a t i on t o : c e r t i f i c a t i on @ a h i ma . o r g 2
P A R T II (co n t i nu ed) To s u ppo r t a r eq u es t fo r t es t acco mm oda t io n s , please s u b m i t t h e follo w i n g m a t e r ials : 1 . A co m p l e t e d AH I M A T e st Acco mm odat i o n R e q u e st Fo r m . 2 . A d e ta il e d , co m p r e h e n s i v e w r i tt e n r e po r t f r o m yo u r t r e at i n g p r of e ss i o n a l d e sc r i b i n g yo u r d i sab ili ty a n d i ts i m pact o n yo u r da il y f un ct i o n i n g . T h e r e po r t s h o u l d a l so e xp l a i n t h e n ee d fo r t h e r e q u e st e d acco mm odat i o n s r e l at i v e to yo u r i m pa i r me n t . T h e r e po r t a n d acco m pa n y i n g doc u me n tat i o n s h o u l d c l e a r l y stat e t h e fo ll ow i n g i n fo r m at i o n : A speci f ic , p r ofessio n ally r ecog n ized diag n osis of t h e d i sab ili ty u s i n g d i ag n ost i c cod e s f r o m t h e c u rr e n t e d i t i o n of t h e D i ag n ost i c a n d Stat i st i ca l M a nu a l of M e n ta l D i so r d e r s (DS M ) o r ot h e r p r of e ss i o n a ll y r e cog n i z e d fo r m u l at i o n . A desc r ip t io n of t h e f un c t io n al li m i t a t io n s r e s u l t i n g f r o m t h e d i ag n os e d d i sab ili ty , i n c l u d i n g t h e i d e n t i f icat i o n of t h e m a j o r li f e act i v i ty t h at i s li m i t e d by t h e d i sab ili ty , a n d h ow t h at m a j o r li f e act i v i ty i s i m pact e d A desc r ip t io n of t h e speci f ic diag n os t ic c r i t e r ia a n d n a me s of t h e d i ag n ost i c t e sts u s e d , i n c l u d i n g dat e (s) of e va l u at i o n , sp e c i f ic t e st r e s u l ts a n d a d e ta il e d i n t e r p r e tat i o n of t h e t e st r e s u l ts . T h i s d e sc r i pt i o n s h o u l d i n c l u d e t h e r e s u l ts of d i ag n ost i c p r oc e d u r e s a n d t e sts u t ili z e d a n d s h o u l d i n c l u d e r e l e va n t e d u cat i o n a l , d e v e l op me n ta l , a n d me d i ca l h i sto r y . Speci f ic t es t r es u l t s u si n g s t a n da r d sco r es s h o u ld be r epo r t ed t o s u ppo r t t h e diag n osis . D i ag n ost i c me t h ods u s e d s h o u l d b e app r op r i at e to t h e d i sab ili ty a n d c u rr e n t p r of e ss i o n a l p r act i c e s w i t h i n t h e f i e l d . A ll sco r e s g e n e r at e d by e ac h t e st m u st b e r e po r t e d i n sta n da r d sco r e fo r m at u s i n g ad u l t ag e -bas e d n o r m s . A n y add i t i o n a l i n fo r m a l o r n o n sta n da r d i z e d e va l u at i o n p r oc e d u r e s s h o u l d b e d e sc r i b e d i n e n o u g h d e ta il t h at ot h e r p r of e ss i o n a l s co u l d un d e r sta n d t h e i r r o l e a n d s i g n i f ica n c e i n t h e d i ag n ost i c p r oc e ss . Copies of r eco r ds r e l at i n g to a n d doc u me n t i n g t h e ca n d i dat e s d i sab ili ty , i n c l u d i n g e d u cat i o n a l , d e v e l op me n ta l , a n d/o r me d i ca l h i sto r y r e l e va n t to t h e d i sab ili ty fo r w h i c h t e st i n g acco mm odat i o n s a r e b e i n g r e q u e st e d . A r eco mm e n da t io n of speci f ic acco mm oda t io n s a n d/o r ass i st i v e d e v i c e s fo r t h e AH I M A e xa m i n at i o n i n c l u d i n g a d e ta il e d e xp l a n at i o n of w h y t h e s e acco mm odat i o n s o r d e v i c e s a r e n ee d e d a n d h ow t h e y w ill r e d u c e t h e i m pact of t h e i d e n t i f i e d f un ct i o n a l li m i tat i o n s . Ide n t i f ica t io n of t h e p r ofessio n al c r ede n t ials of t h e e va l u ato r t h at q u a li fy h i m / h e r to m ak e t h e pa r t i c u l a r d i ag n os i s , i n c l u d i n g i n fo r m at i o n abo u t li c e n s e o r c e r t i f icat i o n a n d sp e c i a li zat i o n i n t h e a r e a of t h e d i ag n os i s . T h e e va l u ato r s h o u l d p r e s e n t e v i d e n c e of co m p r e h e n s i v e t r a i n i n g a n d d i r e ct e xp e r i e n c e i n t h e d i ag n os i s a n d t r e at me n t of ad u l ts i n t h e sp e c i f ic a r e a of d i sab ili ty . If n o p r io r acco mm oda t io n s h ave bee n p r ovided , t h e q u ali f ied p r ofessio n al expe r t s h o u ld i n cl u de a de t ailed expla n a t io n as t o w h y n o acco mm oda t io n s w e r e give n i n t h e pas t a n d w h y acco mm oda t io n s a r e n eeded n o w . I f yo u h av e a n y q u e st i o n s o n t h e doc u me n tat i o n n ee d e d , p l e as e s ee t h e AH I M A Doc u me n tat i o n G u i d e li n e s at : h tp : / / ww w . a h i m a . o r g/ ~ / me d i a / AH I M A/F il e s / C e r t i f icat i o n / AH I M ADoc u me n tat i o n G u i d e li n e s_HR_0918 . as h x 3
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
  • Access to all documents
  • Unlimited textbook solutions
  • 24/7 expert homework help