ADR Intake and Request for Accommodations

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Access & Disability Resources (ADR) is the office at Massasoit that is responsible for providing services and academic accommodations for qualified students with disabilities. Students seeking accommodations will need to fill out this form, submit current and relevant disability documentation and participate in an Intake meeting with an ADR staff member. Please have your Massasoit V# (V00______) and Massasoit email available when filling out this form.

DOB
Please use your Massasoit email
Do you identify as a:

ADR can assist with referrals to additional student services based on voluntary response to this question.

Tell us about yourself

For example, earning a certificate, earning an Associates Degree and going into the workforce, completing an Associates Degree and then transferring to a 4 year Bachelors Degree program or unsure .
for example Fall 2024: Winter 2025, Spring 2025, Summer 2025, Fall 2025, Winter 2026
Will you be requesting accommodations for Placement Testing?
Reading and Math do not have any time restrictions for placement testing. Math has a calculator on the screen for questions that require calculations.

DISABILITY AND DIAGNOSTIC INFORMATION

Disability is defined as "physical or mental impairment that substantially limits a major life activity; a record of such an impairment; or being regarded as having such an impairment" by the American's with Disabilities Act.
Mild, moderate or severe
Have you experienced medical or mental health episode that required an extended hospitalization or absence in the past 2 years?
(please note, Massasoit doesn’t provide aids or coaches for students, students must provide their own support staff and the support staff will need to register with ADR ) please describe

MAICEI (over 22), Mass Commission for the Blind, Mass Rehab Commission, Mass Commission for Deaf and Heard of Hearing, Department of Mental Health, Department of Developmental Disabilities

Accommodation Information

Please answer to the best of your knowledge.

You will have an opportunity to discuss answers more fully when you speak with ADR staff to complete the Intake process. Intake meetings are being conducted over Zoom, on the phone or in person.

Examples, speech to text, text to speech, JAWS, NVDA, audio books, Zoom Text, recording devices, other
Supporting Documentation

Documentation Guidelines:

Generally, documentation is diagnostic testing, evaluative reports or a signed and dated letter from a credentialed mental health provider, medical/clinical specialist or an MD. 

Documentation guidelines can be found at https://massasoit.edu/student-services/dean-of-students/academic-resource-center/access-disability-resources/

 

If you do not have current documentation of your disability, your physician, healthcare provider or mental health practitioner can fill out the Disability Verification Form or they can write a detailed letter regarding your disability. Please see guidelines here: 

 

In addition, you may choose to submit your most recent IEP or 504 Plan, BUT, neither plan is typically considered sufficient documentation on its own. You may choose to submit either document as provisional documentation. 

If you have questions email ADR at adr@massasoit.mass.edu or call ADR at 508-588-9100 x1807. 

ADR Intake and Request for Accommodations form agreement:

By clicking the submit button below, I understand that completing this form doesn’t automatically qualify me for accommodations and/or services . I understand that I will not be eligible to receive accommodations until after current/relevant documentation is reviewed and the ADR Intake meeting is completed.