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Welcome to the Disability Services Request for Reasonable Accommodations form!

Please complete the following form. You will also need to provide formal documentation of your disability.
Documentation Guidelines are available on the Grove City College website (http://www.gcc.edu/Home/Experience-the-Grove/Campus-Life/Disability-Services) or by emailing DisabilityServices@gcc.edu.
Grove City College may require further documentation to substantiate the request for accommodations
All information submitted to the Disability Services Office will be maintained and used in accordance with applicable confidentiality requirements.
Please do not submit original copies of your documentation. All records received by the Disability Services Office at Grove City College will be destroyed seven years after last enrollment term.
Communication from the Disability Services Office will be made using the student's Grove City College email address as the primary mode.
Both this form and supporting documentation must be received before a review will proceed.
If you would like to meet or converse with staff prior to submitting a request, please email DisabilityServices@gcc.edu

Personal Information

Start Term *:
Note: Select when you would like to start your services.
Expected Graduation Term:
Note: Select when you plan to graduate.
First Name *:
Last Name *:
Middle Name:
Optional: Preferred Name:
Student ID:
Hint: Enter 6 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Gender *:

Contact Information

Primary Phone Number:
Hint: Enter 10-digit number only.
Secondary Phone Number:
Hint: Enter 10-digit number only.
Email Address *:

Local Address

Address *:
City *:
State *:
Zipcode *:
Hint: Enter zipcode as 97331 or 97331-0000.

Permanent Address

Same as Local Address

Address:
City:
State:
Zipcode:
Hint: Enter zipcode as 97331 or 97331-0000.

Additional Information

Please select accommodations and services that you have received prior to registering with Disability Services at GCC. This can be accommodations and services provided at your High School or other College/University. If there are none, please leave any selections blank

Prior Accommodations

Requesting Accommodations at DS

Questions

In your own words, describe your disability. * (Required)
Think about how your disability has impacted you in various situations in the past, then consider how it is likely to impact the typical activities you expect to encounter in college. * (Required)
Describe all current disability-related functional limitation(s) of your condition and how they will impact your participation in the academic, living, and extra-curricular programs at Grove City College. * (Required)
Additional information you want to share about yourself and/or your condition. * (Required)

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Disability Services

Grove City College
100 Campus Drive
Grove City, PA 16127

Website: http://gcc.edu/Home/Experience-the-Grove/Campus-Life/Disability-Services
Email Us: DisabilityServices@gcc.edu

Phone: (724) 458 - 2586
Fax: (724) 264 - 4669

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