Accessibility & Accommodations Form

Flint Hills Technical College seeks input from students to assess individual needs. The Dean of Enrollment Management coordinates this process for FHTC in order to determine what resources are available for meeting the accommodation needs of students with disabilities.

All such matters are treated in strict confidence and shall not be discussed except with appropriate personnel.

First Name

Last Name

Phone Number

Email

Address

City

State

Zip Code

Major

Testing accommodation, if requested in a timely manner

Academic Support Services

Auxiliary Aids

Other

Category of Disability

Description of Disability

List of disabilities I am disclosing to FHTC to request accommodations.

I hereby give the Dean of Enrollment Management at Flint Hills Technical College, permission to share information with the following persons/agencies:

Other(s):

I understand that I must provide medical or other diagnostic documentation of my disability and limitations, prepared by a qualified physician, psychologist, or professional, to the Dean of Enrollment Management.

IT IS THE RESPONSIBILITY OF THE INDIVIDUAL STUDENT TO REQUEST ACCOMMODATION OR AUXILIARY AIDS AT LEAST SIX (6) WEEKS BEFORE CLASSES, PROGRAMS, OR ACTIVITIES BEGIN.

AVAILABILITY OF AUXILIARY AIDS

IT IS THE STUDENT’S RESPONSIBILITY TO MAKE WRITTEN REQUEST FOR ASSISTANCE IN OBTAINING SPECIALIZED SUPPORT SERVICES FROM OTHER RESOURCES such as State Vocational Rehabilitation, Recordings for the Blind, State Services for the Blind, etc. For example, the Division of Vocational Rehabilitation (DVR) may fund such items as transportation to the institution, tuition, textbooks, hearing aids, and other individually prescribed devices.

This confidential form will be in effect from the date signed and shall remain effective during my admission to Flint Hills Technical College unless superseded by the signing of a new form.