Accessibility Services Application – River Valley Community College

Name*
First Last
ID (Optional)
Date*
MM slash DD slash YYYY
Phone*
Email*
Program
Advisor
Semester for request*
Describe your learning strengths and preferential learning style. What has worked well for you in the past?*
Describe how your disability or diagnosis impacts your learning or the educational setting.*
What supports or accommodations have you had in place in the past? What worked well for you? What didn't?*
What specific accommodations are you requesting to have in place at RVCC?*