Accommodations Request

Request for Accommodations

The Center for Access and Accommodations at Lewis and Clark Community College provides comprehensive services for students with a documented need for academic adjustments or accommodations, including students with a learning difference(s). To request accommodations, fill out the form below and submit any supporting documents to the Center for Access and Accommodations. If you have any questions, please contact Center for Access and Accommodations at access@lc.edu or (618) 468-4123 or (618) 468-4128.
Email*
example@example.com
Name*

First NameMiddle NameLast Name
Birthdate

MonthDayYear
Phone Number*
Please enter a valid phone number.
Starting Term (please do not submit documentation more than 1 semester prior to term of enrollment)*
My diagnosed disability or disabilities fall into the following categories.*

Attention Deficit DisorderDevelopmental DisabilityHearing or Visually ImpairedLearning DisabledMobility impairedNeurological impairmentAutismPsychological/Emotional ImpairmentOther
How does your disability, illness, or condition affect you academically?*
What accommodations(s) are you requesting?*
Supporting Document(s)

In order to process a request for accommodations, please upload all supporting documentation (Ex. Dr. letter, IEP, 504 Plan, disability testing) If you are unable to upload at this time you may also email all supporting documents to access@lc.edu
Cancelof
Acknowledgement

By submitting this request, I give consent to the Lewis and Clark Community College Center for Access and Accommodations to receive and confidentially store all information and documentation I have chosen to provide. I understand that the Center for Access and Accommodations may verify to other areas of the college that I am eligible for accommodations, however it is my responsibility to inform my instructors and other relevant individuals or departments of my approved accommodations. I am also responsible for informing the Center for Access and Accommodations of any changes to my needs or any assistance I need coordinating my accommodations. I understand that my disability related needs must be clearly communicated to all relevant parties in a timely manner, and that accommodations are not retroactive. I, the student requesting accommodations, declare the truthfulness of the information provided on this form and the attached documentation.
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Request for Accommodations