Student Accommodation Request Form

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Student Information

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If you don't know your student ID number, please type your full name - First, Middle Initial, Last Name

Accommodation History

DCC complies with the letter and spirit of the Federal laws, the Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act. Reasonable accommodations will be determined and approved only after an interactive Intake Meeting or shortly thereafter. Accommodations are based on student self-report and review of appropriate documentation. Accommodations are not retroactive, please self-identify and complete your intake prior to need. OAS staff will make every effort to provide accommodations in a timely manner, but last minute requests for accommodations may not be feasible.

Accommodations do not automatically transfer from high school.

Are you a student with a disability/condition that substantially limits one or more major life activity?Required
Do you need to take placement tests prior to registration?
Are you currently registered for classes?
What semester will you be attending DCC?Required
Did you have an IEP or 504 plan in high school?
Did you receive accommodations at another institution of higher education?
Upload supporting document(s)

Documentation that includes a diagnosis from a physician/clinician or is contained in a psycho-educational testing report is required to complete the Intake process and approve accommodations. Documentation requirements are different depending on the nature of the disability and the accommodation requested. Please see Documentation Requirements on the DCC Accommodative Services website, and be sure to bring documentation to the Intake meeting, if not sent prior to the meeting. We also have a Disability Verification form to guide physicians/clinicians with needed information.  Note: 504 Plans or IEPs are considered useful, but may not include sufficient information necessary to make decisions about accommodations in higher education. 

Housing Accommodations

Residential accommodations may be provided to Conklin Hall students who qualify under the Americans with Disability Act Amendment (ADAA) and Section 504 of the Rehabilitation Act of 1973 Housing application and deposit must be paid and Submission of documentation of a substantial need from a qualified physician/clinician with the following information listed.

Are you requesting housing accommodations?
If you are not registered to vote where you currently live, would you like to apply to register?
Confidentiality Statement

Student’s paper and electronic information is considered confidential pursuant to FERPA, and is kept secured.  Information about disabilities and the use of accommodations is only used to arrange accommodations with other staff and faculty on a need to know basis, and is not recorded on any DCC school record or transcript. In accordance with FERPA, disability related documents will not be released to persons who are not school officials without written consent of the student, unless a FERPA exemption applies.

Documentation and student disability records are confidentially purged after 7 years of inactivity at DCC.