Request for Disability Support Services Form

Prefer to fill out the form by hand? Download the PDF version of the form here.

Last Name
First Name
CC ID
Cell Phone Number
May Disability Services leave a message?
Home Phone
May Disability Services leave a message?
CC Worner Box #
Home Address
CC Email Address (if available)
Personal Email Address (Please note that once activated, your CC email account will be the preferred address for email communication by the Disability Services staff.)
Please describe each disability for which you are requesting services.
How does your disability impact academic and other activities?
Describe accommodations and services you have used in the past, including their effectiveness.
Describe the accommodations and services you are requesting at Colorado College.
Please describe any additional concerns you may have.
Documentation of disability from a qualified professional:

Offices & Services

Request for Disability Support Services Form

If you are a Colorado College student who is requesting disability-related accommodations, please complete the online or PDF version of the Request for Disability Support Services Form and submit it, along with documentation of your disability, to the office of Disability Services. Additionally, please schedule an appointment with the director of Disability Services to discuss your request for accommodations and/or services.

If you need assistance completing the Request for Disability Support Services Form, please contact Disability Services. We are here to help!

Please note: When you click "Send" for the online form, your information will be sent directly to Jan Edwards, director of Disability Services.