Public Accommodation Request

Student Information

Please enter your information.

First Name

Last Name

HVCC Student ID Number

*Only include the 8 numbers after the H (ex. 00654321)

HVCC Email

*Use your HVCC email address (ex. f-lastname@hvcc.edu)

Phone Number

Semester to begin studies

Year to begin studies

Will you be enrolled full time?

*Note: full time status is at least 12 credits.

Please describe your diagnosed disability(ies)

How does your disability impact your life as a student?

Please describe the accommodations you have received in the past

Are you working with an outside agency?

Upload supporting document(s)

*Submit your "supporting documentation" and Release Authorization Form, which must be submitted first before accommodations can be approved.

Consent