Supportive Services for Students with Disabilities Interview Form

* indicates a required field

Student Information

The Office of Supportive Services provides reasonable and appropriate accommodations for students with disabilities in accordance with Section 504 of the Rehabilitation Act of 1973 and the guidelines of the American with Disabilities Act (ADA).

Students with disabilities must self-identify by completing the Interview Form below.

Please use your university issued email address
Have you ever been previously registered with Supportive Services to receive accommodations?Required

Self Assessment

So that we may best understand your needs, please indicate the disability area(s) for which you are requesting accommodations.
My disability affects my academicsRequired
My disability affects me in social/personal settingsRequired
My disability affects me in employment settingsRequired
Disability Information
Please indicate which tasks you feel are a problem. There are no right or wrong answers. Your answers help us determine which supports are most appropriate for you.
Previous AccommodationsRequired

Have you ever used disability accommodations and/or auxiliary aids/services in high school or at another institution?

Please list the accommodations and/or auxiliary aids/services you might need to pursue your academic career at CCAC.

Please note that an appropriate accommodation plan will be developed based on data collected from diagnostic reports and/or information gathered during the initial interview process. Appropriate accommodations are determined by the Office of Supportive Services and may or may not be reflective of past accommodations.

CCAC PoliciesRequired

By checking the box below, I understand the information submitted to Disability Services is confidential and will not be placed in my academic record. I understand that it is my responsibility to review the OSS Student Handbook. I am aware of the availability of the OSS Student Handbook on-line and have the right to request a hardcopy at any time.

Have you ever or would you ever require assistance in the event of an emergency?Required
Upload supporting document(s)Required

Disability related documentation should provide information on the functional impact of the disability so that effective accommodations can be identified. Criteria for the source, scope and content of documentation differs by disability type. Documentation may include assessments, reports, and/or letters from qualified evaluators, professionals, or institutions. Common sources of documentation are health care providers, psychologists, diagnosticians, and/or information from a previous school.

Additional information about documentation requirements is available online.

Documentation must be uploaded in order to complete this interview form and move forward in the process of requesting accommodations. If you do not have documentation available or have questions, please call 412-237-4612.

Please note: Our system does not allow us to view documents uploaded at HEIC files (from Apple products). If you are using an Apple product, please upload the file as a JPG file. See thislink for instructions on how to convert these files.