Fillable Spartanburg Community College Student Intake Form PLEASE PRINT (Spartanburg Community College)

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Spartanburg Community College Student Intake Form PLEASE PRINT (Spartanburg Community College)

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7/22/2020
Spartanburg Community College
Student Intake Form
PLEASE PRINT
Student Personal Information:
Name: _________________________________________________ Date: ________________
Date of Birth: ____________________________ SCC ID#: ____________________________
Address: _____________________________________________________________________
City/State: ___________________________________________ Zip Code: _______________
SCC E-mail: ________________________ Planned major: _____________________________
Telephone: (Day) _____________________________ (Cell) ___________________________
Video Phone/Skype ____________________________________________________________
Program of Study ______________________________________________________________
Spartanburg Community College provides reasonable accommodations to qualified
individuals who have, have a history of, or are regarded as having a disability.
Spartanburg Community College may ask you to provide appropriate documentation to
support your request. Per the ADA: appropriate documentation may include a letter from
a qualified professional or evidence of a prior diagnosis, accommodation, or classification,
such as eligibility for a special education program.'' 73 FR 34508, 34539 (June 17, 2008).
Disability Information:
Please identify your disability_____________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
7/22/2020
What accommodations are you requesting?__________________________________________
____________________________________________________________________________
____________________________________________________________________________
Students will be asked to schedule an appointment with a Student Disability Services
coordinator to discuss their accommodation request. Your file will not be complete until you
have met with a SDS coordinator and received an approved accommodation plan.
Student Disability Services will only discuss your academic accommodations with faculty
or staff of Spartanburg Community College who have a legitimate academic interest, as
defined by the Family Educational Privacy Rights Act (FERPA). Medical documentation
will be kept strictly confidential and will only be viewed by employees of Student
Disability Services, administrators of Spartanburg Community College, and regulatory
agencies in the course of legitimate inquiries. Spartanburg Community College does not
collect genetic information about students.
SCC considers disability documentation confidential, and thus the information does not
become part of a student’s academic transcript. All disability-related documentation,
forms and other related information is housed in the SDS office. Disability documentation
shall be released only in accordance with the law. Documentation is destroyed after seven
years. Student Disability Services recommends that every student keep a copy of his or
her documentation. The SDS office will provide verification that a student is registered
with SDS and has provided appropriate documentation to receive reasonable academic
and support services accommodations; this verification is available to any support
services provider and other office on campus such as AIM, academic advisor, TRIO-
Student Support Services, or The Learning Center. The office of SDS will not make
copies of a student’s original documentation for any party other than the student.
Student Consent:__________________________________________Date:______________
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Spartanburg Community College Student Intake Form PLEASE PRINT (Spartanburg Community College)

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Completed 27 July 2020

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