Center for Access and Accommodations Intake Form

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Student Information

Please enter the student's information
Please use your College issued email address
ex. Semester and Year

Specific Accommodation Information

Choose all that apply
Are you seeking accommodations because you have tested positive for COVID-19?Required
Upload supporting document(s) (Dr letter, IEP, disability testing, COVID positive results, etc)Required

By submitting this request, I give consent to the College of DuPage 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 of 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.