Completing the Initial Contact Form is the first step in assessing your eligibility for disability accommodations at Rocky Vista University. This form is intended for current students, incoming students, and prospective students. If you are not a student but are seeking information regarding disability services at Rocky Vista University, please call us at (435) 222-1241 or email ADAaccommodations@rvu. All information is submitted directly to Disability Services and is kept confidential. If you need assistance completing this form, please contact us. Personal InformationDate(Required) MM slash DD slash YYYY Name(Required) First Last Preferred Name (optional) First Birth Date(Required) MM slash DD slash YYYY This field is hidden when viewing the formRVU Student ID#(Required)Graduation year:(Required)RVU Email Address Personal Email Address Cell Phone Number(Required)Academic InformationProgram of study(Required) College of Medicine (COM) Doctor of Nurse Anesthesia Practice (DNAP) Master of Science in Biomedical Science (MSBS) Master of Medical Sciences (MMS) - Montana Montana College of Osteopathic Medicine (MCOM) Physician Assistant (PA) Campus(Required) Ivins Parker Billings Start Term(Required) I am currently an enrolled student & registered for classes. I am an admitted student & starting in the next academic year. I am a prospective student & considering taking classes during a future academic year. Disability Information:Are you contacting our office regarding a temporary injury?(Required) Yes No Temporary Injury(Required)Date of injuryDescription Add RemovePlease share the diagnosis or condition that prompted you to reach out for accommodations and how your diagnosis or condition impacts you in an academic setting and/or what barriers are you facing?(Required)If multiple, please use the + to list all diagnoses or conditions for which you are requesting accommodations.DiagnosisHow does your diagnosis or condition impact you in an academic setting and/or what barriers are you facing?Barriers Add RemoveAccommodations Being RequestedHave you previously received disability-related accommodations?(Required) Yes No If you have used accommodations in the past, which have been most effective?(Required)What accommodations or services are you currently interested in exploring?(Required)Submit supporting documentation Note that you can meet with Disability Services before submitting documentation. The Disability Officer can discuss any documentation needs during your Welcome Meeting and will explain additional steps to be taken after the meeting. Examples of acceptable types of disability-related documentation: Educational records, such as a high school accommodation plan (IEP, 504 plan, etc.) Medical Records Letter from healthcare professional, on letterhead which confirms a diagnosis, impact of the disability and functional limitations Neuropsychological or educational evaluation Audiology report Vision assessment Proof of accommodations used on standardized exams (MCAT, SAT, ACT, etc.) Disability Verification Form For further information regarding acceptable types of supporting documentation, please click here. Upon Submission: You will be contacted via email within two (2) business days. Communication will be sent directly to the student's official Rocky Vista University email address. If you have not heard from us within two (2) days, please contact our office via email or call (435) 222-1241. Additional questions? Please connect with us at ADAaccommodations@rvu.edu. Please submit documentation of prior accommodations if available. Drop files here or select files Max. file size: 10 MB.