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Accommodations Initial Contact Form

This is the official request form to begin the process of securing academic and/or housing accommodations. Students (not parents or providers) should complete this Accommodations Initial Intake Form and request that appropriate disability diagnostic documentation be submitted to the Academic Success Office from an appropriate healthcare provider. The intake application process is not considered complete and cannot be processed for review until this form AND the diagnostic documentation has been received.
  • SECTION I. Types of Requested Accommodations

    Please check all the accommodations you are requesting.
  • SECTION II. Declared Disability

    According to the Office for Civil Rights, a “Person with a disability means a person with a physical or mental impairment that substantially limits a major life activity; has a record of such an impairment; or is regarded as having such an impairment. The determination of whether a student has a physical or mental impairment that substantially limits a major life activity (and therefore has a disability) must be made on a case by case basis.”

    Select all that apply and then provide the appropriate diagnostic documentation according to the documentation guidelines required for the area of disability.
  • Select all that apply and then provide the appropriate diagnostic documentation according to the documentation guidelines required for the area of disability.
  • SECTION III. Accommodation Requests

    Select the reasonable academic adjustments or modifications that you believe will provide you with equal access to education, housing, meal, or co-curricular activities at PC. (Equal access is defined by the U.S. Department of Education as an equal opportunity of a qualified person with a disability to participate in or benefit from educational aid, benefits, or services.). Indication of these accommodations does not necessarily mean these are the accommodations you will receive. Once received, your diagnostic documentation will provide our office with the information needed to make necessary approvals.
  • Select all that apply and then provide the appropriate diagnostic documentation.
  • Select all that apply and then provide the appropriate diagnostic documentation.
  • SECTION IV. Outside Agency Support

    Select any of the following outside agencies from which you are currently receiving support.
  • Select any of the following outside agencies from which you are currently receiving support.
  • SECTION V. Signature

    Disability-related information is protected by the Buckley Amendment. Information will not be released or discussed without student’s consent except to College officials and faculty having legitimate educational interests and on a need-to-know basis. Students, by submitting this Accommodations Initial Intake Form, you are providing your electronic signature consent for the Academic Success Office to share this information with College officials and faculty, as stated.

    In addition, I understand that my electronic signature affirms that I am registering with the Presbyterian College Academic Success Office as a student with a disability as defined by the Americans with Disabilities Amendments Act and Section 504 of the Rehabilitation Act. I understand that despite my disability,

    1. I must meet the minimum standards as set forth by my program of study, with or without accommodations, keeping in mind that instructors are neither expected to compromise the essential course requirements nor to fundamentally alter a course.
    2. I am responsible for following Presbyterian College’s policies as outlined in the Arts and Sciences Academic Catalog, The Garnet Book, and the Blue Book.
    3. I must complete and submit an Authorization of Accommodations Form to the Academic Success Office each semester and at least two working days prior to the first official day of the semester. Doing so provides the Academic Success Office permission to provide my Accommodations Approval Form to my instructors and/or office campus offices such as Residence Life. (This is not automatically done for me.) Instructors are not responsible for implementing immediate accommodations when students wait until the last minute to complete their Authorization of Accommodations Form.
    4. It is my responsibility to discuss my approved accommodations with each of my instructors.
    5. In addition to this form, diagnostic documentation from a healthcare provider must be received in order for my file to be reviewed for accommodations.
  • Please print first and last name.
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NOTICE OF NONDISCRIMINATORY POLICY AS TO STUDENTS: Presbyterian College is an equal educational opportunity institution. The College’s admission standards and practices are free from discrimination on the basis of age, sex, race, creed, color, disability, ethnicity or national origin.