Disability
Accommodations Form

Please make sure you have answered all of the questions and provided as much information as possible. Leaving blanks can result in a delay or denial of services due to a lack of information.

I am requesting accommodations to provide support related to my disability and will provide documentation of that disability. I understand that:
• The application and documentation provided in support of my request for accommodations shall be kept confidential. Any exception to this would be according to district policy.
• I will receive notification of my accommodations request.
• It is my responsibility to work with IVCCD faculty and Support Services staff to access those approved accommodations.
• Student success is my responsibility.
Approved accommodations will be available each semester/class I am enrolled at IVCCD, it is my responsibility to inform College personnel, in writing, of any changes in my needs for accommodations. IVCCD reserves the right to determine the appropriateness of disability documentation and requests for services on a case-by-case basis. By completing this form and signing below, I am agreeing to follow IVCCD’s policies as a student receiving support services from Iowa Valley Community College District.