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ICCC Accommodation Request
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Student Information
Please enter your information
First Name
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Last Name
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Middle Name
Student ID
Your 7 digit Student ID Number
Email
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Please use your Iowa Central email address
Phone Number
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Which Campus do you plan to attend?
Career Academy
Correctional Facility
East Campus
Fort Dodge
High School
Online
Storm Lake
Webster City
Please enter your first semester of enrollment at Iowa Central Community College for which you are requesting accommodations.
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If you are an incoming student, please enter your first anticipated semester (for example, Fall 2020).
Specific Accommodation Information
My diagnosed disability falls into the following category:
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If "other" please specify
How does your condition impact you in class regarding: listening, note taking, speaking, writing, typing, sitting & attendance?
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Which accommodation(s) are you requesting?
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Upload supporting document(s)
Supporting documents can include a 504, IEP, and/or forms from a medical provider stating a diagnosis. If you do not have supporting documents ready to upload, do not click "add item".
Document Information
Document Title
File
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Maximum file size: 10240kb
Description