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Online Student Application

Two easy steps to register
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
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  3. Hint: Enter 7 alpha numeric characters.
  4. Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Contact Information
  1. Hint: Enter 10-digit number only.
  2. Hint: Enter 10-digit number only.
Local Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  1. Secondary Disability(ies)

    General Category

  2. Affiliation(s)
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.


Prior Accommodations

Test Accommodations
Alternative Formats
Deaf and Hard of Hearing
Other Accommodations
Classroom Accommodations
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.

Requesting Accommodations at OSA

Test Accommodations
Alternative Formats
Deaf and Hard of Hearing
Other Accommodations
Classroom Accommodations
Questions
  1.  
    Have you experienced difficulty in any of the following academic areas? (Check all that apply.)
  2.  
    Do you have any current significant problems with social interactions with other people? Please describe:
  3.  
    Do you have any current emotional problems that significantly interfere with your ability to learn? Please describe:
  4.  
    Have you used any accessible/assistive technology before, including reading or writing software? Please describe:
  5.  
    Is there any other information you would like to share relating to your disability? Please describe:
  6.  
    Office of Student Accommodations Release of Information and Procedures for Emergency Medical Occurrence:
  7.  
    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.
  8.  
    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.
  9.  
    Commonwealth of Virginia Voter Registration Agency Certification - must be answered

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