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Welcome to the Office of Student Accommodations, if you have any questions please contact us at 804-523-5628, 804-523-5290 or email
osa@reynolds.edu
.
Please note applications must be completed in one setting can not be saved for later.
Personal Information
Start Term
*
:
Select One
2023 - Spring
2023 - Summer
2023 - Fall
2024 - Spring
2024 - Summer
2024 - Fall
2025 - Spring
2025 - Summer
2025 - Fall
2026 - Spring
2026 - Summer
2026 - Fall
2027 - Spring
2027 - Summer
2027 - Fall
2028 - Spring
2028 - Summer
2028 - Fall
2029 - Spring
2029 - Summer
2029 - Fall
2030 - Spring
2030 - Summer
2030 - Fall
2031 - Spring
2031 - Summer
2031 - Fall
2032 - Spring
2032 - Summer
2032 - Fall
2033 - Spring
2033 - Summer
2033 - Fall
2034 - Spring
2034 - Summer
2034 - Fall
2035 - Spring
2035 - Summer
2035 - Fall
2036 - Spring
2036 - Summer
2036 - Fall
2037 - Spring
2037 - Summer
2037 - Fall
2038 - Spring
2038 - Summer
2038 - Fall
2039 - Spring
2039 - Summer
2039 - Fall
2040 - Spring
2040 - Summer
2040 - Fall
2041 - Spring
2041 - Summer
2041 - Fall
2042 - Spring
2042 - Summer
2042 - Fall
2043 - Spring
2043 - Summer
2043 - Fall
2044 - Spring
2044 - Summer
2044 - Fall
2045 - Spring
2045 - Summer
2045 - Fall
2046 - Spring
2046 - Summer
2046 - Fall
2047 - Spring
2047 - Summer
2047 - Fall
2048 - Spring
2048 - Summer
2048 - Fall
2049 - Spring
2049 - Summer
2049 - Fall
2050 - Spring
2050 - Summer
2050 - Fall
Note: Select when you would like to start your services.
Expected Graduation Term:
Select One
2016 - Spring
2016 - Summer
2016 - Fall
2017 - Spring
2017 - Summer
2017 - Fall
2018 - Spring
2018 - Summer
2018 - Fall
2019 - Spring
2019 - Summer
2019 - Fall
2020 - Spring
2020 - Summer
2020 - Fall
2021 - Spring
2021 - Summer
2021 - Fall
2022 - Spring
2022 - Summer
2022 - Fall
2023 - Spring
2023 - Summer
2023 - Fall
2024 - Spring
2024 - Summer
2024 - Fall
2025 - Spring
2025 - Summer
2025 - Fall
2026 - Spring
2026 - Summer
2026 - Fall
2027 - Spring
2027 - Summer
2027 - Fall
2028 - Spring
2028 - Summer
2028 - Fall
2029 - Spring
2029 - Summer
2029 - Fall
2030 - Spring
2030 - Summer
2030 - Fall
2031 - Spring
2031 - Summer
2031 - Fall
2032 - Spring
2032 - Summer
2032 - Fall
2033 - Spring
2033 - Summer
2033 - Fall
2034 - Spring
2034 - Summer
2034 - Fall
2035 - Spring
2035 - Summer
2035 - Fall
2036 - Spring
2036 - Summer
2036 - Fall
2037 - Spring
2037 - Summer
2037 - Fall
2038 - Spring
2038 - Summer
2038 - Fall
2039 - Spring
2039 - Summer
2039 - Fall
2040 - Spring
2040 - Summer
2040 - Fall
2041 - Spring
2041 - Summer
2041 - Fall
2042 - Spring
2042 - Summer
2042 - Fall
2043 - Spring
2043 - Summer
2043 - Fall
2044 - Spring
2044 - Summer
2044 - Fall
2045 - Spring
2045 - Summer
2045 - Fall
2046 - Spring
2046 - Summer
2046 - Fall
2047 - Spring
2047 - Summer
2047 - Fall
2048 - Spring
2048 - Summer
2048 - Fall
2049 - Spring
2049 - Summer
2049 - Fall
2050 - Spring
2050 - Summer
2050 - Fall
Note: Select when you plan to graduate.
First Name
*
:
Last Name
*
:
Middle Name:
Optional: Preferred Name:
Student ID:
Hint: Enter 7 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Gender
*
:
Select One
Female
Male
Other/Not Specified
Pronouns:
Select One
he, him, his, his, himself
per, per, pers, pers, perself
she, her, her, hers, herself
they, them, their, theirs, themself
ve, ver, vis, vers, verself
zie, hir, hir, hirs, hirself
Contact Information
Primary Phone Number:
Hint: Enter 10-digit number only.
Secondary Phone Number:
Hint: Enter 10-digit number only.
Email Address
*
:
Local Address
Address
*
:
City
*
:
State
*
:
Select One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Wyoming
International
Zipcode
*
:
Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
Primary Disability
*
:
Select One
=== General Category ===
Apraxia
Aspergers Syndrome
Attention Deficit Disorder
Attention Deficit/Hyperactivity Disorder
Autism Spectrum Disorders
Blind/Visually Impaired
Deaf/Hearing Impaired
Intellectual Disabilities
Learning Disabled
Medical
Motor Impairment
Other
Pervasive Developmental Disorde
Post Traumatic Stress Disorder
Psychological
Speech Impairment
Traumatic Brain Injury
Secondary Disability(ies)
General Category
Apraxia
Aspergers Syndrome
Attention Deficit Disorder
Attention Deficit/Hyperactivity Disorder
Autism Spectrum Disorders
Blind/Visually Impaired
Deaf/Hearing Impaired
Intellectual Disabilities
Learning Disabled
Medical
Motor Impairment
Other
Pervasive Developmental Disorde
Post Traumatic Stress Disorder
Psychological
Speech Impairment
Traumatic Brain Injury
Other Disability or Note:
Affiliation(s)
Affiliation(s)
Dept. for the Deaf and Hard of Hearing
Dept. of Aging & Rehabilitative Services
Dept. of Mental Health
Dept. of the Visually Impaired
Disabled American Veterans/Veterans Administration
Other - please describe below [R]
Additional Note:
Please select accommodations and services that you have received prior to registering with our Office of Student Accommodations (OSA). This can be accommodations and services provided at your High School or other College/University. If there are none, please leave any selections blank.
Access Key to Eligibility Section is "G"
Prior Accommodations
Test Accommodations
A Reduced Distraction Room for Tests and Quizzes
Alternative Format - Use of JAWS for Tests, Exams, and Quizzes
Audio Support use of Kurzweil, or Read-Write
Enlarged Material CCTV
Extended Time for Tests and Quizzes 1 1/2 (50%)
Extended Time Tests and Quizzes 2X (100%)
JAWS (Screen Reader Software)
Testing Center
Text-to-Speech Software
Alternative Formats
Digital Textbooks/E-Text
Deaf and Hard of Hearing
Captioned Media
Instructor/Student use of Assistive Listening Device (FM)
Interpreting
Preferential Seating for Clear View
Real Time Transcribing
Other Accommodations
Computer Software Aid- Word Processor and/or Note Taking Technology
Computer Software Aids Spell Check, Grammar Check, Dictionary/Thesaurus
Emergency Response Assistance
Classroom Accommodations
Digital/Screen Reader in Classroom
JAWS (Screen Reader Software) in Class
Priority Seating
Tape Lecture
Please select services you are SEEKING to request with our office, and provide documentation for your eligibility.
DISCLAIMER: Please be aware that the accommodations you select may or may not be approved. Final approval will be based on your supporting documentation and your interview with the Office of Student Accommodation's Coordinator.
Access Key to Eligibility Section is "G"
Requesting Accommodations at OSA
Test Accommodations
A Reduced Distraction Room for Tests and Quizzes
Alternative Format - Use of JAWS for Tests, Exams, and Quizzes
Audio Support use of Kurzweil, or Read-Write
Enlarged Material CCTV
Extended Time for Tests and Quizzes 1 1/2 (50%)
Extended Time Tests and Quizzes 2X (100%)
JAWS (Screen Reader Software)
Testing Center
Text-to-Speech Software
Alternative Formats
Digital Textbooks/E-Text
Deaf and Hard of Hearing
Captioned Media
Instructor/Student use of Assistive Listening Device (FM)
Interpreting
Preferential Seating for Clear View
Real Time Transcribing
Other Accommodations
Computer Software Aid- Word Processor and/or Note Taking Technology
Computer Software Aids Spell Check, Grammar Check, Dictionary/Thesaurus
Emergency Response Assistance
Classroom Accommodations
Digital/Screen Reader in Classroom
JAWS (Screen Reader Software) in Class
Priority Seating
Tape Lecture
Questions
How do you see these accommodations relating to your disability? How will they support you? Please describe:
*
(Required)
Why were you given those accommodations? How were they helpful for you? Please describe:
*
(Required)
Have you experienced difficulty in any of the following academic areas? (Check all that apply.)
Reading
Spelling
Math
Taking tests
Study skills
Reading rate
Comprehending concepts
Retaining information
Completing assignments on time
Organization
Motivation
Other (Specify Below)
Additional Note or Comment
Do you have any current significant problems with social interactions with other people? Please describe:
Yes
No
Additional Note or Comment
Do you have any current emotional problems that significantly interfere with your ability to learn? Please describe:
Yes
No
Additional Note or Comment
Have you used any accessible/assistive technology before, including reading or writing software? Please describe:
Yes
No
Additional Note or Comment
Is there any other information you would like to share relating to your disability? Please describe:
Yes
No
Additional Note or Comment
Emergency Contact Information: Provide the following information in the box below, name, relationship, and phone number
*
(Required)
Office of Student Accommodations Release of Information and Procedures for Emergency Medical Occurrence:
If your disability could possibly create a situation where you would need emergency assistance please answer yes or no
Yes
No
If yes, there will be a separate form offered for you to complete with the counselor during your initial meeting. This form will be kept on file for the spring, fall, and summer of 1 school year.
Additional Note or Comment
I also give consent for Reynolds Community College to release information to appropriate persons and/or agencies or institutions as per my request. Please check all the apply.
Medical Records
Learning Disability Assessment Reports
Psychiatric Evaluation Results
Vocational Rehabilitation Plan
Audiology and Speech/Language Pathology Report
Accommodation Notification Form
Other (Specify Below)
I give further permission for Office of Student Accommodations (OSA) to discuss my educational situation with other professionals who have a legitimate educational need to know. This authorization shall remain in effect until revoked in writing by the student or by Office of Student Accommodations (OSA), whichever comes first (not to exceed two years from the date submitted.)
Additional Note or Comment
OFFICE OF STUDENT ACCOMMODATIONS STUDENT’S RESPONSIBILITIES - Please check each box as you read. You must type your full name in the comment box. This acknowledges that you have read and agree. Must be signed.
I must request accommodations at the beginning of each semester.
Complete this step by following directions for renewing your accommodations for the upcoming semester on our web page https://www.reynolds.edu/student_services/accommodations/default.aspx
I have the right and responsibility to disclose my disability to instructors, program supervisors or other parties when and if I choose to initiate a request for accommodations.
I am responsible for scheduling with my instructor all tests to be taken using my accommodations:
If taken on line communicate with your instructor about the extension of test time.
If taken on campus communicate with your instructor the location test will be taken at:
College Testing Center or the Testing Center inside the Office of Student Accommodations.
This step MUST BE scheduled at least 3-5 days in advance of the test date as appointment are made on first come and space available.
This is required to ensure that the test will be waiting for the student when they arrive to take a test.
I must inform my instructor if I have a scheduling conflict that requires the accommodated test to be taken more than three hours after the regularly scheduled classroom test.
I will be sure to allow enough time to complete the test:
on line by the published deadline date
on campus if using College Testing Center or the Testing Center inside the Office of Student Accommodations
Tests must be completed during the published hours for each location and by the deadline date provided by the instructor
I will contact the Instructor and/or the Office of Student Accommodations, in the event of an Emergency, to inform them and make the necessary schedule changes.
I will be on time to all classes and tutoring sessions.
I will notify the Office of Student Accommodations if I need books in alternate format at the start of each semester and will follow appropriate procedures for requesting books.
I will notify the Office of Student Accommodations if I need notes transcribed, enlarged, or other specialized services, at the start of each semester by providing copies of my syllabus to assist in scheduling & delivery of those services.
Additional Note or Comment
Commonwealth of Virginia Voter Registration Agency Certification - must be answered
If you are not registered to vote where you live now, would you like to apply to register to vote here today?
I am already registered to vote at my current address
I am not eligible to vote and do not need an application to register to vote.
Yes, I would like to apply to register to vote (please ask counselor at initial appointment for assistance. (fill out the voter registration application form).
No, I do not want to register to vote.
Additional Note or Comment
Additional Note or Comment
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