Please indicate how your disability/condition impacts your functioning:

I am requesting the above accommodations from Lenoir Community College Disability Support Services. I understand that accommodations are based on the functional limitations created by my disability as they impact the standards of the courses within the curriculum for which I am enrolled. I will provide to LCC ADA Counselor, the appropriate documentation that states need and eligibility for the accommodations I am requesting.

I further understand that, upon receiving the Accommodation Form from the ADA Counselor, it is my responsibility to give each instructor a copy and make them aware of the accommodations for which I am eligible.

I give LCC Student Support Services staff permission to share information with LCC officials who have a legitimate educational interest. I also give LCC Student Support Services staff permission to discuss the implementation of the accommodations with appropriate faculty/ staff, if deemed necessary.