ODS NEEDS ASSESSMENT FORM

Please complete this form after you have read the ODS Notice to Barnard Students which describes the services that the Office of Disability Services (ODS) provides.  Students with learning disabilities should read Documentation of a Learning Disability/ADD and forward a copy of their psychoeducational evaluation to ODS.  Complete Part I and the Disability-Related Housing Request Form where applicable.  Complete Part II if you would like to participate in our accommodative aide program.  We hire and train both volunteer and work-study students to serve as readers, tutors, typists, notetakers and other aides for students with disabilities.  We encourage students to volunteer in all aide categories.

NAME                                                                                      CLASS:

ADDRESS/PHONE                                                                      EMAIL:

HOUSING STATUS:  COMMUTER ____  RESIDENT____

STUDENT STATUS:  FIRST YEAR ____  TRANSFER ____  VISITING _____

*************************************************************************

Part I: ALL INFORMATION WILL BE KEPT STRICTLY CONFIDENTIAL

1.  Do you have a disability which limits you in some way?

     YES _____   NO ____ If YES, please state diagnosis: ____________________________

_________________________________________________________________________

    2. Which services would you be interested in receiving? Check any that apply:

___Accommodative Aide                                            ___Disability-related housing (see form)

___Assistive technology (Dragon, Jaws, etc)      ___Sign/oral interpreter/CART

___Counseling                                                 ___Test accommodations

___Disability-related equipment                        ___Other_________________________

___Disability-related financial aid                  

Part II:

1. Would you like to participate in our accommodative aide program?

          YES _____ Volunteer _____ Work-study ______  NO______

2. Have you had any experience with disabled individuals, either through work or school,   family or friends?  YES _____ NO _____

          Please explain ______________________________________________________

Thank you for completing this form.  Please return to: Susan E. Quinby, Director,           Office of Disability Services, Barnard College, 3009 Broadway, New York, NY 10027

ODS  08/08

3