Request for Academic Adjustment and/or Auxiliary Aid

Academic adjustments and/or auxiliary aids are provided for qualified students on an individualized basis according to the specialized needs of each student and the availability of equipment, service providers, and funding. Services may include (but are not limited to) one or more of the services listed below.

Please indicate the academic adjustment and/or auxiliary aids you are requesting along with your current semester schedule by checking all that apply and providing detail when needed:

If you prefer, you may fill out and print the paper form and return to the Disabilities Services Coordinator in Student Services, which is located in the Wilson Building.

Once your request form is submitted, you will be contacted by the Disabilities Services Coordinator to discuss service options.

Please enter your full name.
Please enter your 7-digit JCC student ID
Please provide your preferred telephone number {example 123-456-7890}
Please provide your preferred email address.
If your requested service is not listed above, please list your requested service
REQUIRED INFO - Course Title - Section Number - Day and Time - Instructor Name - Room Number

* Extended time does not mean unlimited time. No more than 2 times the regular allotted time may be granted.