Cowley College Page Content Main Content Navigation Menu Social Media Other Links What is this view? Assistive Options Academic Support Disabilities Services Submit Request For Service * First Name: (required) Middle Initial: * Last Name: (required) * Personal Email: (required) Cowley Email: Home Phone: Cell Number: Work Number: Address: City: State: Zip: Campus Location: Arkansas City Mulvane Wichita Winfield Yes No Yes No Do you receive assistance from Vocational Rehabilitation? (SRS)? Yes No If yes, who is your counselor? 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 Acquired Brain Injury Learning Disabilities Learning Disabilities Chemical Dependence Chemical Dependence ADD/ADHD ADD/ADHD Orthopedic/Physical Disability Orthopedic/Physical Disability Temporary Disability Temporary Disability Blind Blind Psychiatric Disability Psychiatric Disability Deaf Deaf Partial Sight/low vision Partial Sight/low vision Medical Disability Medical Disability Speech Disability Speech Disability Hard-of-Hearing Hard-of-Hearing Hard-of-Hearing Other (Explain) Extended test time Extended test time Test in distraction reduced site Test in distraction reduced site Test read to me Test read to me Note taker Note taker Record Lectures Record Lectures Assistive Technology Software Assistive Technology Software Textbook in alternate format Textbook in alternate format Calculator Calculator Enlarge Print Material/Handouts Enlarge Print Material/Handouts Interpreter (Sign) Interpreter (Sign) Closed Caption Video Closed Caption Video Preferred seating Preferred seating Scribe Scribe Listening Device Listening Device Listening Device Other Accommodation?