Beyond Access Participation Agreement

PURPOSE OF PROGRAM

The Beyond Access program offers individualized services that exceed standard accommodations at the college level. Our program is designed to help students bridge the gap between access and success. We recognize that students have a variety of strengths and difficulties, and we believe in meeting students wherever they are on their journey. We value all aspects of student life, and believe that academic, social, and career skills are all ingredients for a positive university experience. Our purpose is to support students in reaching self-selected goals in these and other areas over the course of a semester.

SERVICES PROVIDED

You have previously been asked to complete an application discussing your learning and social profile. If needed, you then met with a program representative to discuss potential areas of focus as a participant in Beyond Access and the recommended track (number of hours of meetings per week) in which you should enroll to make progress toward those goals.

During the semester, you will meet on a regular basis with your Strategy Instructor. You will create between one to three goals to work toward over the course of the semester. The Strategy Instructor will provide tools, strategies, and approaches individualized to your profile to help you meet your goals. Beyond Access meetings will be scheduled at the Center for Students with Disabilities, virtually, or at another agreeable location.

The benefits of Beyond Access rely upon your commitment and engagement with the program. Your Strategy Instructor is responsible for identifying specific strategies to help you reach your goals; however, you are responsible for applying and utilizing these strategies. Participation in Beyond Access is entirely voluntary and does not guarantee a grade increase or any other specific outcome.

REFUND POLICY
Careful planning goes into the development of resources for Beyond Access, which includes extensive training of the Strategy Instructors. As a result, regardless of whether a student participates in the program, the Center incurs a significant cost. Therefore, if a student chooses to withdraw from the program or determines that they must withdraw from the University after the first day of classes, and prior to the start of the fifth week of classes, the Center will offer refunds according to the following schedule:

No refunds will be offered after the conclusion of the fourth calendar week of the semester. For students beginning the program mid-semester, refunds may be granted on a prorated basis until the conclusion of the fourth week of enrollment.

If you encounter a situation that warrants special consideration for a refund, you may appeal the refund policy. Submit in writing the details of your extenuating circumstances and why you were unable to terminate the agreement prior to the end of the fourth week of classes. Submit any supporting documentation, which can include a letter from your treating medical professional or a staff/faculty member who can provide evidence to support your request. Appeals will be reviewed by a committee of Center for Students with Disabilities staff members. Once a decision is reached, you will be notified via email of the outcome. All decisions made by this committee are considered final. Written appeals should be emailed to Allison Knight, Assistant Director for Assessment and Enhanced Services Programs, at csdbeyondaccess@uconn.edu.

TERMINATION
You or the Beyond Access program may cancel (terminate) this Agreement prior to the end of the current semester for any reason with one-week written notice to the other party. Upon termination by either party, refunds may be granted on a prorated basis up until the fourth week of classes as described in the Beyond Access refund policy. Pursuant to this policy, no refunds will be offered after the fourth week of classes. If you wish to terminate the Agreement, you must send written notice to Allison Knight at csdbeyondaccess@uconn.edu.

CONFIDENTIALITY AND MAINTENANCE OF RECORDS

Your records and personal information are subject to the Family Educational Rights and Privacy Act of 1974 (FERPA) and may only be disclosed with your permission or as provided under the law. For example, FERPA permits schools to disclose your information in the event of a health or safety emergency as determined by University employees. Please refer to the UConn Privacy Program’s information regarding FERPA to learn more. Any information used for research purposes will not include your name or other identifying information.

CONFIDENTIALITY AND MAINTENANCE OF RECORDS(Required)

I authorize CSD to discuss with my parents or family members any academic or personal information pertaining to me.

I authorize CSD to discuss with only specified parents or family members any academic or personal information pertaining to me.

I do not authorize CSD to discuss with my parents or family members any academic or personal information pertaining to me.

List Approved Individuals(Required)

List your approved individuals if you selected: I authorize CSD to discuss with only specified parents or family members any academic or personal information pertaining to me.

TRACK SELECTION(Required)

Track I (1 hour/week - $2,000)

Flex Track I (1.5 hours/week - $2,450)

Track II (2 hours/week - $3,000)

Track III (3 hours/week - $3,950)

Semester charge for Beyond Access: $2,000

Semester charge for Beyond Access: $2,450

Semester charge for Beyond Access: $3,000

Semester charge for Beyond Access: $3,950

ACKNOWLEDGEMENT

This is an enrollment form for the Beyond Access program at the University of Connecticut’s Center for Students with Disabilities. By signing below, you are consenting to all the terms contained in this Agreement.

STUDENT CONSENT OF PARTICIPATION

I acknowledge that I have read and understood this form. I acknowledge that upon submission, I will receive a copy of this form.
I agree to participate in my selected track of Beyond Access. I understand that the fee will be: $2,000.
I acknowledge that I have read and understood the Center for Students with Disabilities’ Beyond Access refund policy. I understand that it is my responsibility to notify the Beyond Access program in writing if I wish to withdraw from the program. I understand that depending on when this notice is provided, I may or may not be entitled to a refund.

STUDENT CONSENT OF PARTICIPATION

I acknowledge that I have read and understood this form. I acknowledge that upon submission, I will receive a copy of this form.
I agree to participate in my selected track of Beyond Access. I understand that the fee will be: $2,450.
I acknowledge that I have read and understood the Center for Students with Disabilities’ Beyond Access refund policy. I understand that it is my responsibility to notify the Beyond Access program in writing if I wish to withdraw from the program. I understand that depending on when this notice is provided, I may or may not be entitled to a refund.

STUDENT CONSENT OF PARTICIPATION

I acknowledge that I have read and understood this form. I acknowledge that upon submission, I will receive a copy of this form.
I agree to participate in my selected track of Beyond Access. I understand that the fee will be: $3,000.
I acknowledge that I have read and understood the Center for Students with Disabilities’ Beyond Access refund policy. I understand that it is my responsibility to notify the Beyond Access program in writing if I wish to withdraw from the program. I understand that depending on when this notice is provided, I may or may not be entitled to a refund.

STUDENT CONSENT OF PARTICIPATION

I acknowledge that I have read and understood this form. I acknowledge that upon submission, I will receive a copy of this form.
I agree to participate in my selected track of Beyond Access. I understand that the fee will be: $3,950.
I acknowledge that I have read and understood the Center for Students with Disabilities’ Beyond Access refund policy. I understand that it is my responsibility to notify the Beyond Access program in writing if I wish to withdraw from the program. I understand that depending on when this notice is provided, I may or may not be entitled to a refund.

Student Name(Required)

First Last

UConn Email Address(Required)

UConn Student ID / PeopleSoft Number(Required)

Date(Required)

Are you over the age of 18?(Required)

Yes

PARENT/GUARDIAN CONSENT OF PARTICIPATION

I acknowledge that I have read and understood this agreement. I acknowledge that my student will receive a copy of this form.
I agree that my student will participate in the selected track of Beyond Access. I understand that the fee will be $2,000
I acknowledge that I have read and understood the Center for Students with Disabilities’ Beyond Access refund policy.I understand that it is my student’s responsibility to notify the Beyond Access program in writing if they wish to withdraw from the program. I understand that depending on when this notice is provided, they may or may not be entitled to a refund.

By filling out the information below, you are agreeing to the above terms.

PARENT/GUARDIAN CONSENT OF PARTICIPATION

I acknowledge that I have read and understood this agreement. I acknowledge that my student will receive a copy of this form.
I agree that my student will participate in the selected track of Beyond Access. I understand that the fee will be $2,450
I acknowledge that I have read and understood the Center for Students with Disabilities’ Beyond Access refund policy.I understand that it is my student’s responsibility to notify the Beyond Access program in writing if they wish to withdraw from the program. I understand that depending on when this notice is provided, they may or may not be entitled to a refund.

By filling out the information below, you are agreeing to the above terms.

PARENT/GUARDIAN CONSENT OF PARTICIPATION

I acknowledge that I have read and understood this agreement. I acknowledge that my student will receive a copy of this form.
I agree that my student will participate in the selected track of Beyond Access. I understand that the fee will be $3,000
I acknowledge that I have read and understood the Center for Students with Disabilities’ Beyond Access refund policy.I understand that it is my student’s responsibility to notify the Beyond Access program in writing if they wish to withdraw from the program. I understand that depending on when this notice is provided, they may or may not be entitled to a refund.

By filling out the information below, you are agreeing to the above terms.

PARENT/GUARDIAN CONSENT OF PARTICIPATION

I acknowledge that I have read and understood this agreement. I acknowledge that my student will receive a copy of this form.
I agree that my student will participate in the selected track of Beyond Access. I understand that the fee will be $3,950
I acknowledge that I have read and understood the Center for Students with Disabilities’ Beyond Access refund policy.I understand that it is my student’s responsibility to notify the Beyond Access program in writing if they wish to withdraw from the program. I understand that depending on when this notice is provided, they may or may not be entitled to a refund.

By filling out the information below, you are agreeing to the above terms.

Parent/Guardian Name(Required)

First Last

Parent/Guardian Email(Required)

GOVERNING LAW. This Agreement shall be construed in accordance with and governed by the laws of the State of Connecticut.
INDEMNIFICATION. The Contractor shall indemnify and hold harmless the State of Connecticut, including any agency or official of the State of Connecticut from, and against all costs, claims, damages, or expenses, including reasonable attorney’s fees, arising from its negligent acts or omissions in connection with the performance of this Agreement.
NONDISCRIMINATION. The parties agree to comply with all applicable state and federal laws, rules, regulations and executive orders governing equal employment opportunity, immigration, nondiscrimination, including the Americans and Disabilities Act, and affirmative action.

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Beyond Access

Beyond Access Participation Agreement

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