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Disability Accommodation Application Form

This document is an application for accommodation services from The Washington Center for Internships and Academic Seminars. It requests information about the student's disability, accommodation needs for housing, internships, classes, and other activities. It asks if the student needs orientation materials in alternative formats or transportation training. It also collects statistical information about how the student learned about the scholarship program and disability services.

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The Washington Center
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144 views3 pages

Disability Accommodation Application Form

This document is an application for accommodation services from The Washington Center for Internships and Academic Seminars. It requests information about the student's disability, accommodation needs for housing, internships, classes, and other activities. It asks if the student needs orientation materials in alternative formats or transportation training. It also collects statistical information about how the student learned about the scholarship program and disability services.

Uploaded by

The Washington Center
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Internships and Academic Seminars

1333 16th Street, N.W.


Washington, D.C. 20036-2205

Application for Services T 202 238 7900  F 202 238 7700


[Link]/info@[Link]

1.0  Student Information

Name

College/University

Email Telephone Cell

Please state the Semester or Term that you are attending The Washington Center: 20_________

 
✔ Summer Term  Fall Semester  Spring Semester
 Summer Quarter  Fall Quarter  Spring Quarter

2.0  Accommodation
We would like your experience in DC to be as positive as possible. For this reason we ask that you let us know what specific
accommodations you will require to fulfill your goals during your stay in Washington, DC.

2.1 What is/are your documented disability/disabilities?

2.2 What accommodations do you need in your apartment or related to your roommate?
Please be as specific as possible, for example: Do not write: I need a fully wheelchair accessible apartment.
Instead write: I need a roll-in shower with a hand-held showerhead, I need a 40” wide doorway, I need cabinets that I can roll under.

2.3 What accommodations do you need within your workplace?


We expect you to self-disclose your disability to your internship supervisor if appropriate and to self –advocate in your internship,
but we need to know what accommodations you are requesting so that we can support you. In the past, some students have requested
particular software for computer work, specific desk height, interpreters, etc.

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Application for Services

2.4 What accommodations do you need in your class?


For example: note takers, more time per assignment, etc. Please be specific.

2.5 Are there any other accommodation needs you can foresee during your stay in D.C.?

2.6 Do you want to participate in a Metro Training session provided by TWC?


 Yes  No

2.7 Do you need orientation and mobility training?


 Yes  No

2.8 Do you have a service animal?


 Yes  No

If yes, what kind?__________________________________

If you need specific accommodations for your service animal, please list them below.

2.9 Do you need orientation and registration materials in an alternative format?


 Yes  No

If yes, what format?

The Washington Center for Internships and Academic Seminars  •  2/3


Application for Services

3.0  Statistical Purposes


3.1 How did you find out about TWC?


3.2 How did you find out about the Scholarship Program for Students with Disabilities?

3.3 Do you use your State Department of Vocational Rehabilitation?


 Yes  No

3.4 Do you use your college or university Career Center?


 Yes  No

3.5 Do you use your college or university office for Students with Disabilities?
 Yes  No

3.6 Are you a member of any student group for students with disabilities? (ex. University group, NYLN, DSU?)
 Yes  No
If so, which one?

Please contact Chris Mason with questions.


Submit
T 202 238 7954
disabilityservices@[Link]

The Washington Center for Internships and Academic Seminars  •  3/3

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