Office for Disability Services
Lincoln College ID Number:
Street Address Line 2
State / Province
Postal / Zip Code
Please enter a valid phone number.
What Lincoln College campus are you planning to attend or are attending?
Lincoln College Traditional Campus - Lincoln, IL
ABE - Normal, IL
ABE - Peoria, IL
ABE - Oglesby, IL
ABE - Lincoln, IL
What degree are you seeking?
Major (if applicable)
Read and check all statements
I understand that it is my responsibility to meet with the Office of Disability Services to determine the accommodations I am eligible to receive as a student at Lincoln College.
I agree to provide necessary documentation of my diagnosed disability, including information regarding the current impact of the disability for the purpose of establishing protection under the law and determining appropriate accommodations. I understand that this documentation is protected by FERPA and will be protected against misuse by others.
I understand that it is my responsibility to learn about and use the various services provided by Lincoln College. I acknowledge that I am responsible for scheduling and participating in necessary appointments with the Office of Disability Services, instructors, testing services, and others involved in providing my accommodations.
I understand that requests for accommodations must be submitted in writing in a timely manner.
I acknowledge that it is my responsibility to keep the Office of Disability Services informed of my current contact information so that I may receive correspondence and notifications.
I understand that I am responsible for the information contained in the Lincoln College Student Handbook and the Office of Disability Services Handbook (both available online).
I acknowledge that it is my responsibility to complete all requirements for the course(s) and program(s) in which I enroll.
What is the nature of your disabilty(ies)?
What is the current impact of the disability(ies) on academis issues?
Describe any accommodations you have already used. Please list them and rate their effectiveness.
How effective was Accommodation 1?
How effective was Accommodation 2?
How effective was Accommodation 3?
How effective was Accommodation 4?
Please list the academic accommodation(s) you are requesting. Include an explanation of how each accommodation would mitigate the impact of the disability. (Requests must be supported by submitted documentation and may not fundamentally alter the nature of the program or pose an undue administrative or financial burden on the College.)
Rationale for Accommodation 1
Rationale for Accommodation 2
Rationale for Accommodation 3
In order to facilitate effective accommodations at Lincoln College, I authorize the Office for Disability Services to discuss relevant aspects related to my disability and accommodations with key individuals and offices at the College. Such communication will not include diagnostic information. Additionally, I authorize the Office for Disability Services to discuss relevant aspects related to my disability and accommodations to the persons listed below. I understand that this information is protected under the Family Educational Rights and Privacy Act (20 U.S.C. § 1232g; 34 CFR Part 99).
If you choose, list an individual not associated with Lincoln College to whom information may be released.
Relationship to Individual Listed
If you choose, list another individual not associated with Lincoln College to whom information may be released.
Relationship to Individual Listed
I acknowledge by my signature that I understand that, although I am not required to release my records, I am giving my consent to release the designated information to the above-named person(s). I understand that this consent will remainin effect unless I revoke such consent in writing and the revocation is received and processed by Lincoln College.
My signature below indicates my agreement to the following.
The information I've listed is correct to the best of my knowledge
I release the following information to the Office of Disability Services: transcript, test scores, progress reports, diagnostic data, and other information from the records pertaining to my enrollment
I acknowledge receipt of an ODS Student Handbook (downloadable at lincolncollege.edu/academics/resources/disability-services)
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