Home Enroll at MGCCC Apply for Admission Students with Disabilities Obtain Accommodations Disability Accommodations Request First-time authorizations require one of two types of documentation for each category of disability accommodations requested. Exit or current IEP from high school, if currently enrolled in high school or if you have graduated within the last 3 years, OR... A letter from a licensed healthcare provider that must contain the following: The letter must be on a licensed healthcare provider's letterhead. The letter must be dated within the last three years. The letter must state a specific diagnosis. The letter must be signed by the licensed healthcare provider. If you have questions or problems submitting the form, please Contact Support Personnel.Authorization Type* First-time Reauthorization Semester* Spring Summer Fall Semester Year* Campus*Bryant Center at TraditionJackson County CampusMaritime Training AcademyHarrison County CampusKeesler CenterNaval Construction Battalion CenterWest Harrison County CenterPerkinston CampusGeorge County CenterName* First Middle Last MGCCC ID (M) Number Date of Birth* MM slash DD slash YYYY Email* Enter Email Confirm Email Phone*Do you wish to continue with your current accommodations?* Yes, I want to keep my options the same. No, I want to change my options. Documentation of DisabilityMedical Diagnosis/Description of Disability*Please select your requested accommodations from the categories below. I request accommodations for:ADD/ADHD* Yes No ADD/ADHD Accommodations* Extra time on tests/quizzes (1.5) Provide instructor’s notes Private room for testing Preferential seating Emotional Support Animal ADD/ADHD Documentation* Drop files here or Select files Max. file size: 50 MB. Anxiety Disorder* Yes No Anxiety Disorder Accommodations* Allow use of calming techniques Extra time on tests/quizzes (1.5) Allow frequent breaks Provide instructor’s notes Private room for testing Preferential seating Anxiety Disorder Documentation* Drop files here or Select files Max. file size: 50 MB. Auditory Processing Disorder* Yes No Auditory Processing Disorder Accommodations* Closed caption all videos Allow use of calming techniques Extra time on tests/quizzes (1.5) Provide instructor’s notes Allow use of an interpreter Private room for testing Preferential seating Allow use of recording device Provide written directions Auditory Processing Disorder Documentation* Drop files here or Select files Max. file size: 50 MB. Autism Spectrum Disorder* Yes No Autism Spectrum Disorder Accommodations* Allow use of assistive software Allow use of calming techniques Allow use of the electronic device Extra time on tests/quizzes (1.5) Allow frequent breaks Provide instructor’s notes Private room for testing Preferential seating Allow use of recording device Allow to type notes/assignments Provide written directions Private Dorm Handicap Accessibility Emotional Support Animal Autism Spectrum Disorder Documentation* Drop files here or Select files Max. file size: 50 MB. Chronic Illness* Yes No Chronic Illness Accommodations* Allow use of calming techniques Drink/snack during class Extra time on tests/quizzes (1.5) Allow frequent breaks Provide instructor’s notes Private room for testing Preferential seating Sit when giving presentations Private Dorm Handicap Accessibility Emotional Support Animal Chronic Illness Documentation* Drop files here or Select files Max. file size: 50 MB. Dysgraphia* Yes No Dysgraphia Accommodations* Allow use of assistive software Allow use of the electronic device Extra time on tests/quizzes (1.5) Provide instructor’s notes Private room for testing Preferential seating Allow to type notes/assignments Dysgraphia Documentation* Drop files here or Select files Max. file size: 50 MB. Dyslexia* Yes No Dyslexia Accommodations* Allow use of assistive software Printouts on colored paper Allow use of digital books Allow use of the electronic device Extra time on tests/quizzes (1.5) Provide instructor’s notes Use colored overlay/pins Private room for testing Preferential seating Orally read test questions Allow use of recording device Allow to type notes/assignments Dyslexia Documentation* Drop files here or Select files Max. file size: 50 MB. Hearing Loss/Deafness* Yes No Hearing Loss/Deafness Accommodations* Closed caption all videos Allow use of calming techniques Extra time on tests/quizzes (1.5) Provide instructor’s notes Allow use of an interpreter Private room for testing Preferential seating Allow use of recording device Provide written directions Private Dorm Handicap Accessibility Emotional Support Animal Hearing Loss/Deafness Documentation* Drop files here or Select files Max. file size: 50 MB. Language Processing Disorder* Yes No Language Processing Disorder Accommodations* Allow use of assistive software Printouts on colored paper Allow use of digital books Allow use of the electronic device Extra time on tests/quizzes (1.5) Provide instructor’s notes Use colored overlay/pins Private room for testing Preferential seating Orally read test questions Allow use of recording device Allow to type notes/assignments Language Processing Disorder Documentation* Drop files here or Select files Max. file size: 50 MB. Learning Disability* Yes No Learning Disability Accommodations* Extra time on tests/quizzes (1.5) Provide instructor’s notes Private room for testing Orally read test questions Learning Disability Accommodations* Drop files here or Select files Max. file size: 50 MB. Low Vision/Blindness* Yes No Low Vision/Blindness Accommodations* Allow use of assistive software Printouts on colored paper Allow use of digital books Allow use of the electronic device Extra time on tests/quizzes (1.5) Provide instructor’s notes Student cannot use Scantron Provide oral directions Use colored overlay/pins Private room for testing Preferential seating Orally read test questions Allow use of recording device Allow to type notes/assignments Use large print Private Dorm Handicap Accessibility Emotional Support Animal Low Vision/Blindness Documentation* Drop files here or Select files Max. file size: 50 MB. Mobility* Yes No Mobility Accommodations* Allow use of digital books Allow use of electronic device Extra time on tests/quizzes (1.5) Extra copy of textbooks Provide instructor’s notes Student cannot use Scantron Private room for testing Preferential seating Sit when giving presentations Allow to stand if necessary Extra time to and from class Private Dorm Handicap Accessibility Emotional Support Animal Mobility Documentation* Drop files here or Select files Max. file size: 50 MB. Neurological Condition* Yes No Neurological Condition Accommodations* Allow use of digital books Allow use of electronic device Extra time on tests/quizzes (1.5) Extra copy of textbooks Provide instructor’s notes Student cannot use Scantron Private room for testing Preferential seating Sit when giving presentations Allow to stand if necessary Extra time to and from class Private Dorm Handicap Accessibility Emotional Support Animal Neurological Condition Documentation* Drop files here or Select files Max. file size: 50 MB. Physical Disability* Yes No Physical Disability Accommodations* Allow use of digital books Allow use of electronic device Extra time on tests/quizzes (1.5) Extra copy of textbooks Provide instructor’s notes Student cannot use Scantron Private room for testing Preferential seating Sit when giving presentations Allow to stand if necessary Extra time to and from class Private Dorm Handicap Accessibility Emotional Support Animal Physical Disability Documentation* Drop files here or Select files Max. file size: 50 MB. Posttraumatic Stress Disorder* Yes No Posttraumatic Stress Disorder Accommodations* Allow use of calming techniques Extra time on tests/quizzes (1.5) Allow frequent breaks Provide instructor’s notes Private room for testing Preferential seating Private Dorm Handicap Accessibility Emotional Support Animal Posttraumatic Stress Disorder Documentation* Drop files here or Select files Max. file size: 50 MB. Psychological/Emotional Disorder* Yes No Psychological/Emotional Disorder Accommodations* Allow use of calming techniques Extra time on tests/quizzes (1.5) Allow frequent breaks Provide instructor’s notes Private room for testing Preferential seating Private Dorm Handicap Accessibility Emotional Support Animal Psychological/Emotional Disorder Documentation* Drop files here or Select files Max. file size: 50 MB. Seizure Disorder* Yes No Seizure Disorder Accommodations* Allow use of calming techniques Extra time on tests/quizzes (1.5) Allow frequent breaks Provide instructor’s notes Private room for testing Preferential seating Private Dorm Handicap Accessibility Emotional Support Animal Seizure Disorder Documentation* Drop files here or Select files Max. file size: 50 MB. Speech Disorder* Yes No Speech Disorder Accommodations* Extra time on tests/quizzes (1.5) Provide instructor’s notes Private room for testing Preferential seating Speech Disorder Documentation* Drop files here or Select files Max. file size: 50 MB. Other Accommodations RequestedVerificationHealthcare Contact* I give permission to Special Populations/Student Disability Services to contact my diagnosing healthcare professional to verify my eligibility for educational accommodations. I understand that this permission extends to the verification process only.Eligibility* By completing and signing this intake application, you are voluntarily disclosing your disability and does not necessarily confirm your eligibility status for services or accommodations. You also understand that the verification process may take several weeks; depending upon the appropriateness of the documentation you have submitted.Confidentiality* In addition, you understand that all information submitted to this office is to be completely confidential and used only in conjunction with this institution’s commitment and obligation to students with disabilities. The documentation you submit will only be used by this office.Release of Information* I hereby give Support Services permission to talk to my instructors, other college officials, and/or related agencies about my needs as they relate to my disability. This Authorization is valid for my total period of enrollment at Mississippi Gulf Coast Community College.Digitally Sign*Type your full name. Mississippi Gulf Coast Community College is an Equal Opportunity Employer and welcomes students and employees without regard to race, religion, color, national origin, sex, age or qualified disability in its programs and activities. For further information, contact the Compliance Officer, P.O. Box 609, Perkinston, Mississippi 39573, telephone number 601-528-8735, email address compliance@mgccc.edu .