Current Student-Accommodations

Request for Accommodations
Danville Area Community College

Request Form

Biographical Data

Today's Date: required

Name(s): required

School ID : required

Birth Date: required

Street Address/PO#: required

Apt#:

City: required

State:

Zip: required

Phone Number:

Alternate Number:

Email: required

Accommodations Requested

What is (are) your condition(s): required

What is the impact of your condition?

The following questions will help you to describe your condition, its impacts and your needs. Review them with your transition team, counselor, parents, and others who can help you anticipate the accommodations and services you will need at college. You may want to write notes to help you present your requests and explain your needs.

It is helpful to think about how your condition has impacted you in various situations in the past; then to consider how it is likely to impact the typical activities you can expect to encounter at college. You may want to pay particular attention to the following contexts:

Classes (lectures, laboratory, physical activity, web based): required

Assignments (reading, writing, calculating, keyboarding):required

Communication (speaking, listening, using phones, using e-mail): required

Evaluation (tests, papers, oral reports, groups presentations/projects): required

Time Constraints (timed tests): required

Attendance (class, laboratory, required activities): required

Campus (mobility; orientation/navigation, transportation): required

Co-Curricular (clubs, organizations, events, athletics): required

Please select an answer for each:

The Danville Area Community College is not obligated to honor disability accommodations from previous institutions.

Accommodation	I have used this before	This has been helpful to me in the past	I am requesting this from DACC	N/A
For class notes
Tape Recorder
Note Taker
To access auditory/oral information
Sign-language interpreter
Assistive listening device
Closed-captioned videos
To access visual information
Talking Calculator
Video-print enlarger
Braille
Computer Assistive Technology
Dragon Naturally Speaking
Other
For tests/exams
Extended time for test/exams
Testing in a quiet, non-distracting environment
Word processor for essay tests
Spell Checker
Calculator
Reader/scribe
Course
Substitute/waiver
Digital Textbook
Reduced load

Other accommodations (please be specific): required

Agreement

Academic requirements that are essential to the program of instruction being pursued by the student or to any directly related licensing or certification requirement will not be modified, substituted, or waived.

I understand and agree to supply appropriate documentation to academic accommodations in order to ascertain if I am eligible for disability services at Danville Area Community College. I further understand that not all students with disabilities will qualify for disability services.

The Danville Area Community College is not obligated to honor disability accommodations from previous institutions.

Academic requirements that are essential to the program of instruction being pursued by the student or to any directly related licensing or certification requirement will not be modified, substituted, or waived.

I understand and agree to supply appropriate documentation to academic accommodations in order to ascertain if I am eligible for disability services at Danville Area Community College. I further understand that not all students with disabilities will qualify for disability services.

I understand to receive, each semester, auxiliary aids and services I must complete a Semester Request for Academic Accommodations form prior to the start of each semester.

The information contained in this form is true and accurate to the best of my knowledge.

I affirm that the information contained in this form is true and accurate to the best of my knowledge.

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