Initial Accommodation Request Form

Student Information

Please complete the following form to request accommodations and supports at TriCounty Technical College.

Any questions concerning this form can be emailed to ARCenter@TCTC.edu.

First Name

Last Name

Middle Name

Preferred Name:

T Number

Email

Please use your TCTC email address.

Phone Number

Program of Study

Are you currently taking classes at TCTC?

Are You A

Condition, Disability, or Challenges

Diagnosed Disability or Condition You're Experiencing

Please provide specific diagnostic information for any disability or condition marked with an (*) above.

Explain your disability or condition and how it impacts your life (daily and academic):

Would you like to be connected to the TCTC SC Vocational Rehab Counselor for additional resources and support?

SC Voc Rehab assists students with disabilites, medical conditions, mental health conditions, etc. during college and with getting employment.

Outside the Classroom Accommodations

These accommodations outside-the-classroom accommodations like temporary accessible parking and using the TCTC lacataion space.

I am requesting non-academic accommodations.

Academic Accommodations

Academic accommodations are adjustments and that include testing, classroom, and academic materials.

I am requesting academic accommodations.

Self-Advocacy

How would you rate your own self-advocacy skills?

If you have a question about something relating to your needs, what is the first thing you plan to do?

Personal Emergency Plan

Is there a chance your condition may impact your ability to communicate about your needs while on campus?

This could be due to a medical condition, an allergic reaction, a mental health condition, etc.

Documentation

Do you have documentation that shows the diagnosis you indicated?

Upload supporting document(s)

Documentation should come from someone licensed to make a diagnosis. Oftentimes documentation will be an evaluation, IEP, 504 Plan, or a letter from your doctor stating a diagnosis and recommended accommodations. Please contact us with any questions!

Documentation Certification

Disclosure Information

By completing and electronically signing this intake application, the signer is voluntarily disclosing a disability and/or related information and requesting accommodations. Disclosure at this time does not confirm eligibility status for services or accommodations, and an intake meeting will need to take place. All information submitted to the ARC is to be completely confidential and used only for the purposes of verification and in connection with this institution's commitment to students with disabilities.

Full Name

By signing you agree that you have read the above statements or had them read to you.