Accommodation Request Form for Summer Programs

Middlebury College (“Middlebury”) recognizes and supports the standards set forth in Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (“ADA”), as amended, which are designed to eliminate discrimination against qualified individuals with disabilities. Middlebury is committed to making reasonable accommodations for qualified students with disabilities as required by law. We would like to take this opportunity to welcome you to the Middlebury community and to ask that you inform us of any disabilities for which you seek accommodation.

Middlebury will endeavor to make reasonable accommodations as required by applicable laws. The process and services ordinarily available at Middlebury are described in more detail in Middlebury's ADA Policy, which is available from the Disability Resource Center or on the web. Qualifying disabilities can include, for example, visual impairments, hearing or mobility impairments, psychological and medical conditions, and learning disabilities which substantially limit one or more of a person's major life activities and may necessitate modifications to the facilities, programs, or services of Middlebury.

The information that you provide regarding any needs will be shared only with those individuals involved in the coordination and facilitation of services and accommodations required to make our programs accessible to you. Middlebury reserves the right to request current documentation of physical and/or mental disabilities prior to the determination and facilitation of appropriate accommodations; documentation requirements are discussed in more detail in the ADA Policy. Both the full ADA Policy and this form are available from the Disability Resource Center in a variety of accessible formats. 

In assessing your needs, you should be aware that our summer sessions can be extremely intensive. The programs can be considered highly strenuous, rigorous, and demanding for any student, including those with accommodations.

Additionally, various campus locations are spread out and include some steep hills. Students with mobility impairments may benefit from acquiring a personal mobility device, such as a motorized scooter, to assist with the navigation of the campus terrain. Please note that this type of personal equipment is the responsibility of the student.

Similarly, Middlebury is not responsible for services of a personal nature. Students with needs in this area are encouraged to consider obtaining a personal assistant or personal care attendant if they are unable to function independently on campus. Students requesting an air conditioner as an accommodation are advised that such requests should be made in accordance with the guidelines established in the Thermal Comfort Policy.

   

*Providing reasonable accommodations requires timely student input.  If accommodations are not requested in a timely manner, it may be impossible for Middlebury to provide them in the earlier portions of the summer program, which could significantly and perhaps irreparably impair a student's ability to participate.

Note: Your request for accommodation MUST be supported by current and adequate documentation. Middlebury’s documentation requirements are discussed in more detail in our ADA Policy, which is available from the Disability Resource Center. Generally, such documentation must: (1) be prepared by an objective professional qualified in the diagnosis of such conditions; (2) include information regarding the testing procedures followed, the instruments used to assess the disability, the test results, and a written interpretation of these results as they pertain to an educational environment and/or participation in the Middlebury’s programs; (3) reflect your present level of functioning in the area related to the particular accommodations being sought; (4) be appropriately recent. Please note that if you are seeking accommodation for a specific learning disability, there are additional documentation requirements described in the ADA Policy.

Whenever possible, this form should be filled out by the student making the accommodation request.

Files must be less than 150 MB.
Allowed file types: gif jpg jpeg png tif doc docx pdf rtf zip.