Dear Student:
Sandhills Community College values diversity in the college community and is
committed to protecting the civil rights of its members. In accordance with Section 504 of the
Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 (ADA), the college
strives to provide each disabled student with the support services and accomm
odations
necessary to ensure equal access to all college programs and activities. A “disability” is
defined by law as physical or mental impairment that substantially limits one or more major life
activities. Disabilities may include, but are not limited to, sensory, mobility, learning,
psychological or other chronic medical conditions. If you require special services, please
complete this form and return it to the Coordinator of the Office of Disability Services (ODS),
Shalishah Russell. You may also submit the form by email at russells@sandhills.edu.
If you have a disability and need services or accommodations, please complete this
form and return it to the Coordinator of the Office Of Disability Services (ODS), Shalishah
Russell. You may also submit the form by email at russells@sandhills.edu. In addition,
current information must be provided from a licensed professional about your disability and
need for accommodations. The cost and work of obtaining supporting information is the
responsibility of the student. At a minimum
the documentation should include the nature,
extent, and educational impact of the disability and a description of the course of treatment,
medical side effects, and prognosis for the future. The documentation must be from a
professional qualified to make the diagnosis and include the evaluator’s name, address,
telephone number and professional credentials relevant to the diagnosis written on
professional letterhead, signed and dated. Specific information on documentation
requirements can be found on the Sandhills Community College Disability Services website.
Note: If the information provided is incomplete or inadequate to support an accommodation
request, additional information may be required and may result in delays.
Office of Disability Services
115 Logan Hall
(
910) 246-4138
Accommodation Request Form
Student Number:
Student Name:
Phone:
City:
State:
Zip:
Date:
Address:
Area of Disability:
Ac
commodations Requested:
