Office of Accessibility - Student Intake Form

* indicates a required field

Applicant Information

Please allow fifteen to thirty minutes to complete this intake. If you must leave the session before completing the form, your information will not be saved, and you will need to begin again. Please note required fields.  

(include any leading zeroes)
Please use your university issued email address
Are you requesting an accommodation for a temporary impairment?Required

It is essential that the information on this form is filled out in full as it is considered in the eligibility determination process. Timely submission of materials is vital for the timely provision of accommodations. Documentation in accordance with college documentation guidelines may be requested.

Individuals are recommended to first meet and discuss with individual instructors the impact, duration and functional limitations of the temporary impairment within the classroom and/or learning environment before meeting with OA.

Accommodation Requests

Note: Accommodations are approved based on the supporting documentation you provide and an intake interview with a counselor in the Office of Accessibility.

Attach any supporting documentation as needed.
Supporting Documentation

Acknowledgments and Agreements

Consent for Exchange of Information

In order to provide appropriate educational services, it is often necessary for the staff in the Student Wellness Center and the Office of Accessibility to discuss and exchange information with others.  With the understanding that these staff members will exercise professional discretion when disclosing any confidential information, I hereby give permission for these staff members to exchange relevant information, concerning my education, as needed.

STUDENT RESPONSIBILITIES

Rowan-Cabarrus Community College offers support services to any qualified student with a disability who requests such services. It is each student’s responsibility to make use of these services.

Every student is reminded that he or she is ultimately responsible for his/her academic success and/or failure and for his/her own work and grade in each course. The Office of Accessibility encourages you to use time, facilities, and support services in a productive manner. The Office of Accessibility also encourages you to seek guidance in academic and personal matters through us if your find yourself struggling with coursework.


The Office of Accessibility will not be held responsible for acts of misconduct committed by any student. It is the responsibility of each student to know and abide by all RCCC and Office of Accessibility policies, rules, and regulations. We encourage you to make yourself familiar with these polices, rules, and regulations. Failure to do so will not exclude the student from reprimand, punishment, or any other consequence of violating any RCCC or Office of Accessibility policy, rule, or regulation.

 

As a student registered with disability services I agree to the following:

·       I must request accommodations and complete an accommodation form each semester

·       I must request accommodations in advance; accommodations for in class work and/or tests are not automatic and are not retroactive

·       I am responsible for keeping both instructors and disability services informed as to the implementation and effectiveness of an accommodations

·       I must adhere to the RCCC student behavior standard described in the RCCC catalog

·       If I qualify for testing accommodations, I agree I am responsible for scheduling my exams through the testing center or disability services at least 48 hours in advance

·       I agree to notify my instructor of the scheduled test date, time and location

My signature below acknowledges the Consent for Exchange of Information, and will remain in effect during my enrollment here at RCCC, or until it is revoked in writing from me.  My signature below also acknowledges that the Student Responsibilities have been explained and that I am fully aware of my responsibilities as it relates to my request for accessibility services.  My failure to follow these guidelines may result in a delay or interruption of services or accommodations.