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Application for Disability Services


In order to receive Disability Services at Kirtland Community College, you must complete the application below. Recent documentation of your disability signed by a professional must be provided prior to receiving disability services.

Process for Requesting ADA Accommodations

  1. Submit completed Application for Disability Services.
  2. Submit professional documentation to support your disability in order for Disability Services to assess what accommodations are reasonable and appropriate. Documentation can be attached to this form.
  3. If documentation is not attached to this application, you must submit it to the Disability Services office, located in the Student Services corridor at the Grayling Health Science Center in Grayling.
  4. Upon receipt of proper documentation, the Disability Services office will email you to let you know that you will need to schedule an appointment for intake.
  5. Meet with Disability Services to discuss accommodation requests.
  6. Disability Services will review and assess the granting of reasonable and appropriate accommodations.

 
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Applicant Information

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Involved party 1

Barriers & Accommodations

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Is your disability documented by a professional? (Examples would be a doctor or a psychologist.)(Required)
You must make at least one selection.
Have you used accommodations in a school setting before? (Through an IEP or Section 504 plan)(Required)
You must make at least one selection.
This field is required.
What accommodations are you requesting to utilize at Kirtland?(Required)
You must make at least one selection.
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Please indicate any other agencies you are working with for your disability:
You must make at least one selection.
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By submitting this form, I understand that I am applying for disability services and that the services requested must be supported by approved medical documentation of my disability. Documentation is required prior to receiving disability services and must be recent (within 5 years of this application or within your high school education years).(Required)
You must make at least one selection.
By submitting this form, I agree that upon approval for services, my information may be shared with my Academic Advisor(s), Instructor(s) and/or the Director of Housing as needed for accommodations purposes. Documentation cannot be released to a third party by the College.(Required)
You must make at least one selection.
I understand that my personal information (i.e. diagnosis, nature of academic issue, testing information, etc.) will not be discussed unless this information is necessary in providing the accommodation (example: visual/auditory needs). I give permission to Disability Services to coordinate accommodations with my instructors, academic advisor and/or the Director of Housing. I understand that this release is valid for the entire time that I am a student at Kirtland Community College.(Required)
You must make at least one selection.

Supporting Documentation

IMPORTANT: Attach proof of disability. If you do not have the ability to attach this documentation to this application, please submit this information to the Disability Services office within Student Services via fax at (989) 563-5933 or in person. Please remember that an IEP must be accompanied with a psychological evaluation. You can get this paperwork from your high school. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission