Forms For New Students/Requests

Requests for Medical, Military, or Disability-Related Accommodations

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Choose the "Save" option when using the Microsoft Word documents. If you wish to "Open" the file and are prompted for a username/password, click "Cancel" and it will open.

After you have filled out a form, be sure to SAVE it to your computer. Please submit forms to CampusAccess@newhaven.edu as an attachment.

1. Campus Access Services Intake Packet: to be submitted with appropriate documentation, see Documentation Guidelines

A. CAS Intake Form: filled out once when first registering with CAS

CAS Intake Form [ PDF Format | Word Format ]

B. Additional Forms to assist you with registering with CAS:

To release information from your appropriate diagnosing professional to CAS: to be submitted to appropriate diagnosing professional
- Release to Obtain Confidential Information [ PDF Format | Word Format ]
Documentation of ADD/ADHD (must be current within the past 3-5 years):
- Confirmation of ADD/ADHD (student information) [ PFD Format | Word Format ]
- Documentation of ADD/ADHD (professional information) [ PDF Format | Word Format ] - MUST be completed by appropriate professional
Documentation of a Psychiatric/Emotional Disorder (must be current within the past 3-6 months):
- Confirmation of a Psychiatric Disability (student information) [ PDF Format | Word Format ]
- Documentation of a Psychiatric Disability (professional information) [ PDF Format | Word Format ] - MUST be completed by appropriate professional

2. Modifications to Housing/Dining Packet: (all forms must be completed for request to be heard by the Committee)

Please review Modifications to Housing/Dining Policy before completing these forms and submitting your documentation.
Intake Form for Modified Housing/Dining [ PDF Format | Word Format ] - not required if a CAS Intake form is already on file
Request for Modifications to Housing/Dining Options (student information) [ PDF Format | Word Format ]
Request for Modifications to Housing/Dining Options (professional information) [ PDF Format | Word Format ] - MUST be completed by appropriate professional
Modified Dining Options Meeting Form [ PDF Format | Word Format ] - must be completed if requesting modifications to dining options
Release for ADA/504 Review Committee [ PDF Format | Word Format ]

3. Temporary Medical Conditions:

Please see Policy on Temporary Medical Conditions prior to completing this form and submitting your documentation.
Temporary Medical Conditions Intake Form [ PDF Format | Word Format ] - to be submitted with appropriate documentation, see Documentation Guidelines

4. Personal Care Attendant Agreement:

Please see the Policy on Personal Care Attendants prior to completing this form.
Personal care Attendant Agreement and ID Request [ PDF Format | Word Format ]