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Part C - Academic Accommodations
If there are specific academic accommodations that you’d like to discuss with the Coordinator of Disability Services, use
the space below to briefly describe the accommodation(s). Regardless of whether you specify accommodations or
choose to leave this section blank, the Coordinator will advise you of all accommodations related to your disability or
situation which may be available to you while attending classes at GCC.
Special Permit Parking requests are handled by the GCC Public Safety Office.
For information about special permit parking, go to http://www.gcc.mass.edu/safety/parking/.
The GCC Public Safety Office is located in S110 (Main Campus Building) and may be reached by calling (413) 775-1212.
Part D - External Support
If you would like the Coordinator of Disability Services to know that you receive external support, check all applicable
boxes from the following list or use “Other” to write-in the name of an external support.
Mass Rehab Commission
Mass Commission for the Blind
Clinical & Support Options
Mass Commission for Deaf and Hard of Hearing
Mass Department of Mental Health
Part E - Consent
If after reading this section, you understand and agree to the following consent statements, please sign and date below.
However, if you have questions, do not sign below until you have discussed your questions with the Coordinator of
Disability Services and are clear about what you are agreeing to.
I authorize GCC’s Office of Disability Services to review my disability related documentation that I’ve either
provided or released to Disability Services in order to determine eligibility for academic accommodations and to
compose an Accommodation Agreement on my behalf which specifies my eligibility for and lists the
accommodations that are reasonable to use while at GCC.
I authorize GCC’s Office of Disability Services to disclose information related to my disability needs to appropriate
College personnel participating in the accommodation process or working on my behalf for the purpose of ensuring
that reasonable and appropriate services are in place to assist me.
I have read, understand, and agree to the above terms.