Cowley College

Academic Support

Disabilities Services

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Request For Service
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Do you receive assistance from Vocational Rehabilitation? (SRS)? Yes No   If yes, who is your counselor?
Do you receive assistance from Vocational Rehabilitation? (SRS)? Yes No   If yes, who is your counselor?
Acquired Brain Injury
Learning Disabilities
Chemical Dependence
ADD/ADHD
Orthopedic/Physical Disability
Temporary Disability
Blind
Psychiatric Disability
Deaf
Partial Sight/low vision
Medical Disability
Speech Disability
Hard-of-Hearing
Other (Explain)
Extended test time
Test in distraction reduced site
Test read to me
Note taker
Record Lectures
Assistive Technology Software
Textbook in alternate format
Calculator
Enlarge Print Material/Handouts
Interpreter (Sign)
Closed Caption Video
Preferred seating
Scribe
Listening Device
Other Accommodation?