2. Recommended accommodations: please mark only those accommodations that are necessary as
a direct result of the student’s disability.
Note-takers
Extended Testing Time
Test Reader
Private Testing
Alternative Textbook Formats—E-les
Classroom aide
Other _____________________________________________________________
3. Additional comments/information that would help us better serve this student.
Signature
________________________________________________________________________________
Certifying Professional and Title (physician, psychiatrist, psychologist, licensed counselor)
Print Name ______________________________________________________________________________
Address _________________________________________________________________________________
_________________________________________________________________________________________
Phone
__________________________________________________________________________________
Date ____________________________________________________________________________________
Please mail or fax (fax number is (815) 479-7836) the completed form to
Access and Disability Services at MCC, Room A256.
Please include your office cover sheet or cover letter.
click to sign
signature
click to edit