Student Accommodations Request

Required

Studentrequired
First Name
Last Name
Must contain a date in M/D/YYYY format
Parent/Guardian or student filling out applicationrequired
First Name
Last Name
Must contain only numbers

Diagnosis information

Is the student's diagnosisrequired
Attach up to 1 file at a time. File size may not exceed 10MB
No file chosen
Disability falls into the following category(ies):required
Must contain only letters and spaces

History of Accommodations

Have you used accommodations before?required

RELEASE AUTHORIZATIONS 

EC Learning Support staff engages in an interactive and collaborative process with students and their families in order to determine eligibility for reasonable accommodations. Part of the process includes the submission and review of documentation related to the reported disability or limitations. At times, additional information may be requested. Documentation provided to the Learning Support staff is confidential and only shared with other offices or personnel at EC as necessary to put accommodations into effect. The identification of your disability is kept confidential, unless accommodations are approved and activated and then we will share the information with your teachers and counselors to best serve the student. Disability information may be released upon the student and guardian signing the Student Accommodation Plan.
I understand that any authorizations I make here may be withdrawn by student and guardian at any time through a written, signed and dated request.  
Parent/Guardian signaturerequired
Must contain a date in M/D/YYYY format