CONFIDENTIAL Office of Student Support Disability Release Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Instructions: Students requiring accommodations must complete and return this Disability Release Form at least one month prior to the start of each semester. Recent documentation of disability and completed intake documents must be on file with the Office of Student Support. Documentation regarding a learning disability, ADHD and all other disabilities must be updated every 5 years (this requirement does not apply to physical or sensory disabilities of a permanent or unchanging nature). Psychiatric documentation must be updated each calendar year. Accommodations cannot be provided without appropriate documentation. Please complete this form in its entirety.

Email *

I am requesting accommodations for the semester indicated below *

Summer Semester

Fall Semester

Spring Semester

Accommodations for the Placement Test

PRAXIS Testing

CELP

NCLEX

Other:

Required

Student ID Number *

First Name *

Last Name *

Street Address City and State *

Zip Code *

Cellphone Number *

RCBC Email Address *

Accommodation Plan Release *

I hereby give the Office of Student Support permission release my Accommodation Plan for distribution and to inform college officials of my disability(ies) should the need arise.

Required

Emergency Information: In the event of an emergency, please enter your location and a phone number where you can be reached. *

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Rowan College at Burlington County. Report Abuse

Forms