Disability Accommodations Form IVCCD Accommodations Form The purpose of this application form is to gather information about your educational and support needs while a student at IVCCD. Please complete the application process in advance of the start of classes. The student is encouraged to complete this application and submit documentation as soon as they are aware of a disability-related need for services. This information helps us work with you to plan effective academic adjustments, auxiliary aids, and services during your time as a student at IVCCD. This is the first step in the application process. You will receive an email with instructions on how to continue the application process. Campus(Required)ECCMCC/IV GrinnellBusiness and Community Solutions/Adult Basic EducationWhich campus will you be attending?First Name(Required) Last Name(Required) Date of Birth(Required) Preferred method of Contact(Required)PhoneEmailPhoneEmail Disability Information - What is your disability?Have you received accommodations for the disability in the past? Yes No Please describe where you received accommodations from, what those accommodations were, and how they helped with your learning.While attending IVCCD, what specific accommodations do you think will help you be successful? Extra time for tests Other testing arrangements Alternative format textbooks Extra time for assignments Use of adaptive aids Study skills tutoring Assistance animal in campus housing (ECC and MCC campuses only) Other Please specify what other accommodations would help you be successful. 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.PLEASE TYPE YOUR NAME TO INDICATE SIGNING(Required) Typing your name is considered digitally signing this document.