Self Disclosure Form

* indicates a required field


Welcome to the Online Application for Disability Services. If you have an immediate need to access campus for a visit or orientation, please contact the DS office directly.

This Application is intended for currently admitted QVCC students who are first-time registrants with the DS office and who wish to arrange an intake meeting to discuss accommodations for school.  Please complete all applicable items on the form and submit any supporting medical documentation regarding your disability so that we may best understand your needs.  If you have previously requested accommodations through this form, and want to view your request and associated materials, you should log into QVCC's Accommodate Portal. 

If you do not enter all the *required information, the form will not be submitted successfully.  Check for the "Successfully Submitted" response.

After completing this Application you will receive an email instructing you to schedule an intake meeting to discuss your request.  When scheduling your meeting, please indicate if you will require any accommodations for the meeting, such as interpreters or large print. DS engages in an interactive process with each student and reviews requests for accommodations based on an individual's particular situation and needs.

Please enter your 8-digit student ID number (e.g. 01234567)
Please use your university issued email address

Specific Accommodation Information

Did you receive academic assistance in high school?


While you are a vital source of information, DS may request you provide information from other sources in order to establish a disability and the impact it has on learning in a postsecondary environment. If you have documentation regarding your disability, please upload it now. If not, you will be able to upload your documentation later. You may also email documents to or or mail them to the College.If you have questions about what type of documentation is needed, please visit our webpage and view the procedures.

Upload supporting document(s)
Acceptable Documentation: States a specific diagnosis from a physician/clinician or is contained in a psycho-educational testing report Is comprehensive (identifies diagnostic procedures and results) Describes the current functional impacts including how the learning process and what academic tasks may be substantially limited Is recent (ideally within the last 3 years for learning and 1 year for medical or psychiatric) Includes recommendations for accommodations Has been prepared by a properly credentialed professional who has no personal relationship with the student Please note: Documentation will be reviewed with the DS Office on an individual case-by-case basis Accommodations will be determined through an ongoing interactive process Documentation by itself does not guarantee specific accommodations Additional documentation may be required IEPs and 504 Plans are useful but may not sufficient without additional documentation
Confidentiality StatementRequired
Student's DS paper and electronic information is considered confidential pursuant to FERPA and is kept secured.  Information about disabilities and the use of accommodations is only used to arrange accommodations with other staff and faculty on a need to know basis, and is not recorded on any QVCC school record or transcript.  In accordance with FERPA, disability related documents will not be released to persons who are not school officials without written consent of the student, unless a FERPA exemption applies.  Students have the right to review the contents of their files with a Disability Services Provider.

QVCC complies with the letter and spirit of Federal Laws, the Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act.  Reasonable accommodations will be determined and approved only following an interactive Intake Meeting.  Accommodations are based on student self-reporting and review of appropriate documentation.