Register with our Office

Disability Support Services provides services to students with documented disabilities.

Current students can register with the Office of Disability Support Services by following these steps:

1. Review eligibility and documentation guidelines here.

2. Submit documentation of your disability or diagnosis to the Director of Disability Support Services. This can be accomplished by email (elockhart@ehc.edu), by fax (276-944-6180), or by mail (see below). Please include a cover sheet if information is sent via fax, in order to maintain confidentiality.

Director of Disability Support Services
Powell Resource Center
Emory & Henry College
P.O. Box 947
Emory, VA 24327

3. Submit the Disability Disclosure and Accommodation Request Form, found below. This form initiates consideration for all accommodation requests and must be submitted by the student to the Director of Disability Support Services via fax, mail, or email.

4. Meet with the Director of Disability Support Services. You can make an appointment by emailing elockhart@ehc.edu or by calling 276-944-6144.

Disability Disclosure and Accommodation Request Form

Please submit this form to request accommodation for a documented disability. This form should be submitted in addition to any documentation of disability, which should be mailed, emailed, or faxed to the Director of Disability Support Services. Please contact elockhart@ehc.edu with any questions or concerns. This form should only be completed by current students and/ or admitted students who have deposited. This form is not necessary for emotional support animal applications. Please contact the Director of Disability Support Services for information about emotional support animals.

A note about confidentiality: Please note that this form will be submitted electronically and sent via email. Confidentiality of its contents may not be guaranteed. If you would prefer to complete paper copies of this form, please contact elockhart@ehc.edu for electronic or hard copy versions.

Helpful terminology:

*Disability includes a physical or mental impairment that substantially limits one or more major life activities. Major life activities include such things as caring for oneself, performing manual tasks, walking, sitting, standing, lifting, reaching, seeing, hearing, breathing, learning, and working.

**Reasonable accommodations include modification(s) or adjustment(s) to the educational or residential environment of the college to enable a student to meet and perform requisite academic standards or to enjoy equal benefits and privileges of education or college housing.

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Student Name*

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Date*

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Year*

Freshman

Sophomore

Junior

Senior

Admitted Student

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Email Address*

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Phone Number*

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Please identify and describe the physical, cognitive, or psychological disability that is a basis for your request for reasonable accommodations by the college. Please be specific.*

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Please describe how this disability affects your academic work, class schedule, class location, and/ or residential living situation.*

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Identify and describe the reasonable accommodation(s) needed to enable you to meet or perform the academic standards of your educational program and/ or use and enjoy college housing.*

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Identify and describe any equipment, aids, and/ or services that you currently use and are willing to provide and/ or utilize.

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Did you receive special education services in high school?*

Yes

I'm not sure

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Did you transfer from another college of university?*

Yes

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If you transferred from another college or university, please list the name of the college or university from which you transferred.

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Are you a consumer of services from the Department of Aging and Rehabilitative Services or Bureau of Services for the Visually Impaired?*

Yes

I'm not sure

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If you are a consumer of services from the Department of Aging and Rehabilitative Services or from the Bureau of Services for the Visually Impaired, please give your counselor's name and phone number.

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Please describe any accommodations you were granted in previous educational settings.

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Do you request assistance in arranging for your reasonable accommodations?*

Yes, I request assistance in arranging for my reasonable accommodation(s).

No, I am not requesting accommodations at this time, but would like to be registered with the Office of Disability Support Services (DSS), should accommodations become necessary.

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If you request assistance in arranging for your accommodations, please select the semester for which you are requesting accommodations.

Current Semester

Next Fall Semester

Next Spring Semester

Next Summer Semester

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Information concerning your disability will be treated confidentially. With your permission, information concerning your approved accommodations will be shared with staff and/ or faculty at the college on a "need to know" basis in order to provide approved accommodations. By typing your name, you sign this form electronically. By signing, you give Emory & Henry College permission to share information concerning your accommodations with campus professionals who "need to know" (professors, advisors, residential life staff, etc.) and to work with you to complete an Accommodation Plan for you to give to your professors, advisor, and other appropriate campus officials.*

Please type your full name and date.

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