Accommodations Request Form

For assistance with this form, please contact Student Success at ssc@prattcc.edu or 620-450-2156.

Semester

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Disability as described on IEP or documentation

Have you submitted documentation of your disability?

Do you qualify for Vocational Rehabilitation?

Who is your VR Counselor?

Please check the accommodation(s) you believe you will need this semester.

Audio Textbooks

Note Taker/Recorder

Extended Test Time

Non-Distractive Testing Environment

Test Reader

Calculator (not permitted for Basic Applied Math)

Multiplication/Addition table for Math Exams

Other

Other: Please Explain.

Terms

I hereby grant permission to Pratt Community College to release information to appropriate instructors and staff concerning my special needs and accommodations while enrolled in college.

I agree with these terms

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Terms

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