Richmond Community College Disabilities Services Intake Form

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    Information about Disability or Medical Condition

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    In the event I would have an emergency while I am at Richmond Community College, I give my permission for RCC to disclose information related to my condition to emergency personnel and to the individuals listed below.

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    Electronic Signature

    By checking the box below and typing your name into the Signature box, you are confirming that the above statements are true. You agree that by typing your name, you are electronically signing this document.
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