Public Accommodation Request

* indicates a required field

Student Information

Please enter your information
Please write your first name as it appears on your GCC ID.
Please write your last name as it appears on your GCC ID.
Optional
Please enter your 8-digit GCC ID number. Do not include the @ sign.
Please use your GCC issued email address, ending with "@mail.ct.edu".
Please provide the best phone number to reach you.
Have you previously received accommodations in school?Required
This would include high school, college, or other relevant academic programs.



Are the academic adjustment(s) you are requesting temporary?Required

Accessibility Specific Information

Instructions: There is much variability within each accessibility category, and therefore, the type of academic adjustment needed can vary significantly. Below, you will find various types of disabilities recognized in the United States. Student needs vary according to each individual. Therefore, it is important for the participating student to clarify the particular needs they may have.
Please select all that apply. Please note, for every diagnosis selected, students should also submit supporting documentation.
Upload supporting document(s)