ADA TAP/EXCELSIOR ELIGIBILITY
Students disabled as defined by the American with Disabilities Act (ADA) who are attending
part-time (3-11 credits per semester) may be eligible for a New York State TAP award and/or
Excelsior Scholarship. All other state eligibility requirements must be met, including satisfactory
academic progress and enrollment in coursework towards degree. The award and NYS aid
usage points shall be prorated based on number of credits enrolled. This form is for JCC
purposes only; all state applications must be completed to receive NYS aid. See HESC.NY.GOV
for more information.
Student’s Name: ________________________________________________________________
JCC ID: J00___________________________ Phone: _________________________________
Address: ______________________________________________________________________
The ADA defines a disability as a physical or mental impairment that substantially limits one or
more major life activities. Submit documentation of the student’s disability with this
application. It should include:
Diagnostician’s credentials
Statement of diagnosis
Manner used to evaluate student including any standardized testing measures and
scores obtained
Student’s ability to perform major life activities
Recommendations for reasonable accommodations
Please note: The JCC Accessibility Services Office can assist you in gathering this information.
They can also assist you with accommodations such as extended time for testing, assistive
technology, textbooks in alternate format, and temporary handicapped parking upon request.
My signature below authorizes the JCC Accessibility Services Office to notify, in compliance with
the Family Educational Rights and Privacy Act (FERPA), the TAP certifying officer in the JCC
Financial Aid Office of my eligibility for ADA. I can revoke this authorization at any time by
submitting a written, dated, and signed request to the Accessibility Services Office.
Applicant Signature: ______________________________________ Date: _______________
To submit this form:
Accessibility Services Office
Jamestown Community College
525 Falconer Street
Jamestown, NY 14701
For assistance completing this form, please contact The JCC Accessibility Services Office at the
Learning Center at the Jamestown Campus 716.338.1017 or Cattaraugus Campus 716.376.7516;
or the Academic Center at the North County Center 716.363.6500.
