Disability Accommodation Request

Current or Prospective Student Information

This form should be completed by the student requesting services.

If you need assistance with this form, please contact us by Voice/Relay at 262.691.5318.

If you are a community member attending an event on campus and need accommodations, please contact the Student Accessibility Office for assistance. Do not complete this form.

First Name

Last Name

Middle Name

Do you have a WCTC Student ID#?

If you don't have a student ID number, one will be created for you.

Email

Please use your college issued email address, if applicable.

Confirm Email

Date of Birth

Cell Phone Number

High School Attended

High School Graduation Year

Intended Start Date

Disability Information

My diagnosed disability falls into the following category

How does your disability affect you academically?

Have you worked with the Student Accessibility Office in the past?

Disability Documentation

To be eligible for services, you must provide supportive documentation regarding the nature and scope of your disability (academic, medical and/or psychological evaluations, individual education plans and summary of performance, etc.). Please have a qualified professional complete the most appropriate form(s):

Upload supporting document(s)

(Medical, IEP, Audiogram, Psychological, Other)

If unable to upload your documentation, you may email the documentation to sao@wctc.edu or fax to 262-691-5081.

Disability Accommodation Request

Current or Prospective Student Information

Disability Information

Disability Documentation

Document Information