Form: Reasonable Accommodations request

Reasonable accommodations may be requested using the following procedure:

You must submit a completed Accommodations Request form
You must submit an appropriate physical/psychological evaluation or DARS/ARS testing that clearly documents a disability and supports the need for accommodation(s).
You must contact a Disability Services counselor prior to the beginning of each semester to discuss accommodations needed for testing and/or classroom instruction.
You must turn in your request and paperwork to the Advising office located in the Administration building a least two weeks prior to when the accommodation is needed. Scheduling of interpreters and other modified equipment request must be made 4 weeks prior to when the accommodation is needed.
All students are expected to abide by the Student Code of Conduct as outlined in the Student Handbook.

Please complete the following questions

Name

Student ID#

(current TC students)

Local Address

Street Address City State ZIP Code

Phone

Email

Date of birth

MM

DD

YYYY

Major

Do your have a physical or learning disability for which you will need classroom or testing accommodations? If yes, please describe your disability.

(i.e., dyslexia, cerebral palsy, ADHD, siezures, psychological)

Does your condition substantially limit you in any Major Life Activities?

Please explain:

How does your condition affect your learning in the classroom or testing situation?

What accommodations, if any, have you received in the past in testing and educational settings?

(high school, college)

List the specific types of accommodations that you are requested for classroom and/or testing at Texarkana College.

List your DARS or ACE counselor's name, address and phone number

(if appropriate)

Provide the name, address and phone number of your high school

(if appropriate)

Were you exempted from any legal requirement for graduation from high school, such as TAKS?

Please add any additional information that you believe would help us evaluate your educational needs at Texarkana College.

Affirmations

I have read and understood the information on the accommodations request form.
I agree to comply with the procedure and stipulations.
I certify that the information I have provided is accurate and true and can be shared with the appropriate faculty/staff, if accommodations are needed.