(e.g., test-taking accommodations, books in alternate format, sign-language interpreters, etc.).
(e.g., air conditioning, strobe alarms, wheelchair accessible housing, food allergy).
(e.g., service dog, FM system, wheelchair, adaptive technology).
Certification: I certify that the information provided on this form is accurate. I understand that to be eligible for disability services at MVCC I must (1) submit this completed form, (2) submit disability documentation that substantiates the requested accommodations, and (3) participate in an intake interview with a Disability Services staff person. My signature authorizes DSO to discuss my documentation with the clinician who authored the documentation, if additional information or clarification is required.

Documentation from a licensed professional: is enclosed should be sent separately to OAR@mvcc.edu