New Student Intake

Name*

First

Last

Student ID*

Phone*

TCC Email Address*

All faculty, staff and students are expected to check their TCC email on a frequent and consistent basis in order to ensure that they are staying current with all official communications.

When will you start classes?*

On which campus will you attend classes?*

Disability

Please check all that apply

Learning disability
medical disability (including vision and hearing)
Psychiatric/psychological disability
Other

Educational History

Please describe any support services or devices you have used in previous academic settings.

Have you experienced difficulty in any of the following academic areas?

Check all that apply

Reading/writing
Math
Taking tests
Retaining information
Other

Please specify

Are you receiving services from any of the following agencies?

Check all that apply

Department of Ageing and Rehabilitation Services (DARS)
Department of Veterans Affairs
Other

Please specify

Information contained with the file will be kept confidential and will not be shared with anyone outside TCC without your expressed authorization. The college requires that this form and appropriate documentation of disability be submitted 30 days prior to receiving the appropriate accommodations. Once the intake is complete and submitted you may schedule an appointment with the Educational Accessibility Counselor on your campus of choice to discuss accommodations, procedures, and policies.

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