Fillable DISABILITY SERVICES ACCOMMODATION REQUEST FORM (Ogeechee Technical College)

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DISABILITY SERVICES ACCOMMODATION REQUEST FORM (Ogeechee Technical College)

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DISABILITY SERVICES
OGEECHEE TECHNICAL COLLEGE
Admissions: 912.688.6994 | Registrar: 912.486.7221 | Disability Services: 912.486.7211 | Financial Aid: 912.681.5500
ACCOMMODATION REQUEST FORM
First Name Last Name Date
Student ID Cell Phone Current Semester
For which semester are you requesting an accommodation? (Ex. Spring 2017, Fall 2017)
List each course and instructor for which an accommodation is requested:
Course #1 Instructor
Course #2 Instructor
Course #3 Instructor
Course #4 Instructor
Course #5 Instructor
Course #6 Instructor
Indicate your requested accommodations. Use the blank space near “other” to type in your request for
accommodations not listed.
F 50% extended time for quizzes, exams, and in-class assignments
F 100% extended time for quizzes, exams, and in-class assignments
F Private testing location
F Use of computer for note taking
F Permission to audio record lectures
F Access to lecture notes/power points if available
F Use of calculator for exams/quizzes unless it compromises the essential function of course
F Screen reader for quizzes, exams, in-class assignments
F Assistive listening device
F Communication Access Realtime Translation
F Other
You may only request accommodations for which you have had prior approval. Schedule a meeting to discuss any
new requests for reasonable accommodations.
Accommodation Letters will be emailed to your OTC email address.
The Ogeechee Technical College does not discriminate on the basis of race, color, national origin, sex, age or disability. Title IX Coordinator, Office 198C, Joseph E. Kennedy Building,
912.486.7607, titleix@ogeecheetech.edu.; ADA/Section 504 Coordinator, Office 189, Joseph E. Kennedy Building, 912.486.7211, adacoordinator@ogeecheetech.edu;
One Joseph E. Kennedy Boulevard, Statesboro, GA 30458. Ogeechee Technical College is a unit of the Technical College System of Georgia.
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DISABILITY SERVICES ACCOMMODATION REQUEST FORM (Ogeechee Technical College)

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Completed 25 July 2020

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