Public Accommodation Request

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Student Information

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First Name

Please write your first name as it appears on your GCC ID.

Last Name

Please write your last name as it appears on your GCC ID.

Middle Name

Optional

Student ID

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".

Phone Number

Please provide the best phone number to reach you.

Have you previously received accommodations in school?

This would include high school, college, or other relevant academic programs.

Please share what accommodations you've received in the past (if not applicable, please write N/A)

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

What academic adjustment(s) are you requesting?

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.

My diagnosis falls into the following category

Please select all that apply. Please note, for every diagnosis selected, students should also submit supporting documentation.

How does your diagnosis affect you academically?

How does your diagnosis affect student life in general, like taking tests and studying?

Upload supporting document(s)

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Public Accommodation Request

Student Information

Accessibility Specific Information

Document Information