Application for Accommodations

This form should be completed when a student has indicated his or her desire to request a reasonable accommodation from the college. Upon completion, this form will be delivered to the director of student development.

Completion of this form will enable Southwestern to become more familiar with your educational and support needs while you are attending college. It is your responsibility to provide current professional documentation regarding your disability. This documentation must verify your need for the specific accommodation(s) requested. Planning ahead is essential to ensure that accommodations can be met in a timely matter.

Please upload current professional documentation regarding your disability or send separately to Deb Pantini, Director of Student Development at pantini@swcciowa.edu.

Documentation should be current within three years, but exceptions may be necessary dependent upon individual circumstances and disability.

By completing this form I authorize the office of the director of student development at Southwestern Community College to exchange information with Southwestern faculty and staff members as may be necessary for me to apply for and/or receive reasonable accommodations related to my disability.  I understand the exchanged information may be kept confidential and will be limited to the following:

• General information about the disability and how it affects my academic or personal performance.
• Information about my learning modality and recommendations for specific accommodations.

I understand completing this form is only the initial step in the accommodation process. Once I am registered with SWCC disability services, I will need to contact the director of student development each semester to request accommodations and complete accommodation forms for faculty. 

I also understand I am my own advocate. It is my responsibility to request accommodations and to notify instructors of my need for accommodations. It is also my responsibility to report any concerns I may have regarding accommodations to the director of student development. 

I understand that documentation of my disability must be provided to the disability services office before accommodations will be provided.

I certify that the foregoing statements are complete, accurate, and true to the best of my knowledge.  I also understand the college may require me to undergo testing or evaluation by medical personnel for the purpose of establishing the existence and extent of my disability and my need for a reasonable accommodation, if any.