TESU Academic Accommodation(s) Request

You will have as much time as you need to complete this form. However, if there is inactivity on the form for a period of time, you run the risk that your information will be lost and you have to start over.

If you have questions prior to filling out the form please reach out to ADA@tesu.edu.

* indicates a required field

Student Information

Please enter your information

First NameRequired *

Middle Name

Last NameRequired *

Preferred Name

Preferred Pronouns

Ask Me She, Her, Hers, Herself He, Him, His, Himself They, Them, Theirs, Themself Ze, Hir, Hirs, Hirself No Pronouns (Use My Name) Prefer Not To Say

Student IDRequired *

If you do not yet have a TESU Student ID, use your Legal Last Name and Last 4 digits of SSN. (Example: If your name is Thomas Edison and SSN is 123-456-789; your Student ID would be 'Edison6789'.)

EmailRequired *

Please enter the official email address that you are using for all university communications.

Mobile NumberRequired *

If no mobile number, then number at which you can be reached at all times

Do we have permission to send you a text message at this number? Required *

Do we have permission to send you a text message at this number? Yes Do we have permission to send you a text message at this number? No

I am or will be attending as a(n):Required *

I am also:Required *

Active-Duty Military Veteran Military Spouse/Dependent None of the Above/Not Applicable

Consent to Release/Receive Information

For this section, check the parties you authorize the Office of Student Accessibility Services at Thomas Edison State University to obtain or to release information pertinent to receiving academic accommodations and/or services.

Parent/Legal GuardianRequired *

Parent/Legal Guardian Yes Parent/Legal Guardian No

Parent/Legal Guardian First & Last NameRequired *

Parent/Legal Guardian Email AddressRequired *

Parent/Legal Guardian Phone NumberRequired *

Please include Zip Code; for example: (123)456-7890.

Spouse/Family MemberRequired *

Spouse/Family Member Yes Spouse/Family Member No

Spouse/Family Member First & Last NameRequired *

Spouse/Family Member Email AddressRequired *

Spouse/Family Member Phone Number

Please include Zip code; for example: (123)456-7890.

Diagnostician who diagnosed the disabilityRequired *

Diagnostician who diagnosed the disability Yes Diagnostician who diagnosed the disability No

Diagnostician First & Last NameRequired *

Diagnostician Email Address

Diagnostician Phone NumberRequired *

Please include Zip code; for example: (123)456-7890.

Licensed Health Care ProfessionalRequired *

Licensed Health Care Professional Yes Licensed Health Care Professional No

Licensed Health Care Professional First & Last NameRequired *

Licensed Health Care Professional Email Address

Licensed Health Care Professional Phone NumberRequired *

Please include Zip code; for example: (123)456-7890.

Specific Accommodation Information

I am requesting accommodations related to a disability.Required *

I am requesting accommodations related to a disability, as described by the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973.

I am requesting accommodations related to a disability. Yes I am requesting accommodations related to a disability. No

I am requesting accommodations related to a temporary short-term injury and/or illness.Required *

I am requesting accommodations for broken limbs, concussion, etc.

I am requesting accommodations related to a temporary short-term injury and/or illness. Yes I am requesting accommodations related to a temporary short-term injury and/or illness. No

I am requesting pregnancy or postpartum or parent/parental responsibilities of a newborn accommodations.Required *

I am requesting accommodations under NJSA 18A: 3B-74.

I am requesting pregnancy or postpartum or parent/parental responsibilities of a newborn accommodations. Yes I am requesting pregnancy or postpartum or parent/parental responsibilities of a newborn accommodations. No

Identify the Term for which you are requesting accommodation(s).Required *

Note: Academic Accommodation(s) must be requested prior to the start of the Term.

Please select the category(ies) which best describe your disability(ies):Required *

Have you used accommodations at a previous high school or college?Required *

Have you used accommodations at a previous high school or college? Yes Have you used accommodations at a previous high school or college? No

How does your disability affect you academically?

What is the nature of your temporary injury and/or illness?Required *

How long will you be limited due to your temporary illness and/or injury?Required *

When did the temporary injury and/or illness occur?Required *

What academic accommodation(s) are you requesting?Required *

Please select the appropriate disclosure option:Required *

Please select one.Required *

Please select one. If approved, I will be given the opportunity to request up to two no cost course extensions. Students opting for this accommodation will not be excused from completing Discussion Forums in online courses during the original term. Please select one. If approved, I request to be withdrawn from my course(s) and, when possible, to have the registration cost credited to my student account to use in a future term(s). Students should refer to the University’s Course Withdrawals and Refunds webpage.

Withdrawal Information

Students electing a course withdrawal are made aware of the following:

Self-paying students will have the tuition costs for this course/courses credited to their University account for use in a future term.
Students utilizing financial aid will have their account reviewed by the Office of Student Financial Accounts to determine if there is remaining credit to be applied. Students are advised that adjustments to student financial accounts can take five (5) business days to appear.
Students can access their financial account via Online Student Services (https://www.tesu.edu/current-students/student-self-service)

Parenting of a Newborn

If approved, your request will allow for up to two no-cost course extensions for the courses indicated on this form. Students opting for this accommodation will not be excused from completing Discussion Forums in online courses during the original term.

Documentation Requirements

Documentation requirements for students with disabilities

Students requesting academic accommodations and support services through the Office of Student Accessibility Services are required to submit documentation to verify eligibility under Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA, 1990; ADAAA, 2008). As defined by Section 504 and the ADA, an individual with a disability is a person who has a physical or mental impairment which substantially limits a major life activity, including learning. Academic accommodations are implemented to provide equal access to university programs and services.

See directions provided on Requesting Accommodations and Determining Eligibility for Reasonable Academic Accommodations (All information and documentation is kept confidential)

It is important to understand that academic accommodations are not retroactive. Students must complete the application and approval process for receiving academic accommodations related to the above bulleted conditions prior to beginning their Thomas Edison State University coursework, unless they can provide written documentation demonstrating why they were not able to do so. Additionally, students are required to complete a Term Accommodation Request at the start of every term in which they take TESU courses or examination(s).

Documentation requirements for disabled students who used accommodations previously at a different institution.

Students providing a record of previously approved accommodations (IEP, 504 Plan), regardless of age, and who are requesting the same academic accommodation(s) for TESU courses may be eligible for an expedited accommodation plan that does not require them to submit the documentation to verify their disability. Please upload a record of previously approved accommodations (IEP, 504 Plan).

Documentation requirements for temporary injury and/or illness

See directions provided on Requesting Accommodations and Determining Eligibility for Reasonable Academic Accommodations (All information and documentation is kept confidential)

Documentation requirements for pregnancy, postpartum, or parent/parental responsibilities of a newborn

Please upload documentation that verifies that you are pregnant, postpartum, a parent of a newborn or have parental responsibilities of a newborn as defined under NJSA 18A: 3B-74.

Documentation Upload

Please refer to the information above regarding what type of documentation you are required to provide.

Once a student's documentation and verification have been received, reviewed, and approved, they will receive an Approved Academic Accommodations letter. All students approved for academic accommodations are required to complete a Term Accommodations Request within the first week of every term in which they are asking to have accommodations activated. Please refer to "Completing the Term Accommodations Request" as found on the Resources page.

Students who are unable to upload files, can submit disability documentation/verification via secured fax to 609-337-4731 or by mailing to:

ADA Coordinator
Office of Student Accessibility Services
Thomas Edison State University
101 W. State Street
Trenton, NJ 08608

ada@tesu.edu
Office / Fax / Text: (609) 337-4731

Note: Students are advised that mail is routed through and opened by the University’s mail service, who have all signed a confidentiality agreement.

TESU Academic Accommodation(s) Request

Student Information

Consent to Release/Receive Information

Specific Accommodation Information

Documentation Requirements

Document Information