Accessibility Services Intake Form

* indicates a required field

Accessibility Services

Accessibility Services Mission

Accessibility Services works in partnership with the college community to facilitate equal access for students with disabilities to the educational programs, services, and activities of Parkland College in accordance with federal law. 

Steps to Complete Process for Accommodations

Please fully complete the information requested in this form. Official documentation of disabilities must be submitted to Accessibility Services to qualify for accommodations. All students must be qualified to participate in the program before accommodations can be granted and accommodations will not be provided if they fundamentally alter the nature of the program.

Confidentiality

Parkland College considers disability documentation confidential information that does not become part of a student’s academic transcript. Disability documentation is released only in accordance with applicable state and federal laws and Parkland College policies and procedures.

Support from Accessibility Services

If this form is not accessible or you need assistance, please contact Accessibility Services at accessibilityservices@parkland.edu, call 217-353-2338, or visit room U260 at Parkland College.

Type of class:Required
Please type date of class or placement exam:Required

Questions

What is your primary language?Required
Please enter the start date of the class or date of placement exam: Required
My diagnosed disability falls into the following category(ies):Required
Has the student used accommodations in the past? Required
Policy StatementRequired

Accessibility Services (AS) treats as confidential, any written or electronic material obtained to verify a disability, to plan for appropriate services, or to document services and contacts with this office. The following are guidelines used by Accessibility Services regarding disability-related information: All disability-related information regarding students is treated confidentially and only accessible to AS staff and administrators. All disability-related information is kept in secure locations with separate files for each student. AS utilizes secure, password-protected, electronic databases to store student information, student documents, and records of appointments. This information is accessible only to authorized AS staff. Paper documents that have not been saved to the secure electronic databases are housed in secure filing cabinets in the AS office. Students who request services/accommodations acknowledge that some basic level of disclosure to select faculty is necessary to provide the requested accommodation(s).

If additional disclosure is needed, it will occur with the student’s specific written permission with the understanding that only necessary information for the purposes of accommodation will be communicated. A student may request to review the contents of his/her own paper and/or electronic file.

This review must be done in the presence of an AS staff member. All information in the file is the propertyof AS. Students may receive copies of only disability-related records verifying the disability and the need for services and accommodation(s). Students must provide a written request for the copies. Five (5) years after the last date of enrollment, all materials in a student’s folder in AS may be destroyed. Students seeking the release of their academic records will need to sign Parkland College’s FERPA form in Admissions, room U-214.

AcknowledgementRequired

Completing this application is only the first initial step in the disability accommodation process. I need to schedule my evaluation appointment with Accessibility Services. Documentation of your disability must be received by our office at least one week prior to your scheduled appointment. 

Uploading Requirements

Please upload documents providing evidence of the disability so that Accessibility Services can evaluate the request. For youth, please provide an IEP or 504 plan so we can best meet your needs. The College reserves the right to modify documentation requirements to be consistent with current best practices in higher education and on a case-by-case basis. In general, our office strives to align with the principles and recommendations of the Association on Higher Education and Disability (AHEAD), the leading organization for postsecondary disability service providers (Association on Higher Education and Disability (AHEAD) website). 

Drop files here to upload
Non- Discrimination Statement
Non-Discrimination Statement Please see Policy 3.02 in the Parkland College Policy and Procedures Manual for information about the following statement: Harassment or discrimination based on race, color, gender, gender expression, national origin, religion, age, veteran status (including Vietnam veteran), marital status, ancestry, or disability, or retaliation for complaining about harassment or discrimination is a violation of federal and state law. Harassment and discrimination are prohibited in all areas of the College. Appropriate preventive measures shall be used within the College to promote respect for the rights of coworkers and students. Remedial measures and/or corrective actions, up to and including dismissal, shall be utilized when acts of harassment or discrimination occur.