Connect with Access and Equity

Student Name Student Name First Middle Last
Student Cell Phone Number Student Cell Phone Number - ### - ### ####
SUNY Delhi Email
Student 800#
Must be 9 digits. Currently Entered: 0 digits.
Term and Year of Entry (example Fall 2022)

Semester and year
Program
What type of accommodation are you interested in?
Please describe the disability that necessitates your need to have a housing accommodation.
Describe the accommodation which you believe is necessary for you to have equal access to the campus living environment
Provider Name Provider Name First Last
Provider Address Provider Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Provider Phone Provider Phone - ### - ### ####
I authorize SUNY Delhi to receive information from the provider listed above. I also authorize my provider to discuss my condition(s) with the appropriate College personnel to make a determination of reasonable and necessary accommodations. By completing this form, I am verifying that the statements and documentation have been provided by me. I understand that providing false information would constitute a violation of the SUNY Delhi Student Code of Conduct and might result in disciplinary action.

I authorize SUNY Delhi to receive information from the provider listed above. I also authorize my provider to discuss my condition(s) with the appropriate College personnel to make a determination of reasonable and necessary accommodations. By completing this form, I am verifying that the statements and documentation have been provided by me. I understand that providing false information would constitute a violation of the SUNY Delhi Student Code of Conduct and might result in disciplinary action. I agree
ACCES-VR Counselor Name
ACCES-VR Counselor Phone Number ACCES-VR Counselor Phone Number - ### - ### ####
Type of Disability

Please be specific
How does your disability affect your daily living? (academics, housing, dietary, other, etc.)
If you had accommodations approved in high school and/or by another college, please list the approved accommodations
What accommodation(s) are you requesting in order to have equal access to the College's services, programs, and/or activities?
On Campus

On Campus To receive accommodations students must submit documentation and will need a personal appointment before the start of the semester to address individual needs.
Online

Online Online students should refer to the “Online Students Support” link found on our website at www.delhi.edu/aes.
Partnership Site

Partnership Site Students taking classes on partnership campuses please refer to our website at www.delhi.edu/aes under the “Partnership School Services” link.
Please indicate which partnership site
Upload Documentation (Maximum of five files)

Attach Files
Stay connected! – Important student information will be sent to your Delhi email address. Log in often to check your inbox for information regarding required paperwork from offices such as, Residence Life, Access and Equity, Health Services, Financial Aid, and more.

You may contact the Access and Equity Coordinator to discuss issues related to Access and Equity Services by email at accessandequity@delhi.edu.