Voluntary Disclosure, Office of Disability Services, UNCG

CAMPUS LINKS

For more information about the Office of Disability Services, please contact:

Davis Lee
Interim Director,
Office of Disability Services
(336) 334-5440
ods@uncg.edu

Voluntary Disclosure

The University is committed to equality of educational opportunities for qualified disabled students. The Office of Disability Services looks forward to working with you. All the information that you provide is voluntary and will be kept strictly confidential. Who qualifies? Section 504 of the Rehabilitation Act of 1973 defines a handicapped person as "any person who has a physical or mental impairment which limits one of life's major activities such as walking, talking, seeing, hearing, or writing."

Policies and Procedures Yes, I have read the Policies and Procedures manual.

Individual Requesting Services

Name: First, middle, last

Date Of Birth (MM/DD/YYYY)

Street Addresss

City, State (NC) Zip

Home Phone

Local Phone

E-Mail

Your Classification

Semester Entering UNCG

Your Major

Nature of your disability

Request for Accommodation

Academic Accommodations being requested at UNCG

If you have housing requests that goes beyond the terms of current contract(i.e. single room) requests should include details regarding necessity. THIS FORM DOES NOT TAKE THE PLACE OF THE HOUSING APPLICATION. Please visit University's Housing web page at http://hrl.uncg.edu

Housing Accommodations being requested at UNCG

Rehabilitation Agency

Are you registered with a rehabilitation agency? yes no

Name of agency

Name of counselor

If you have questions regarding proper documentation of your request for accommodation, please contact the Office of Disability Services at 336-334-5440. Once documentation is received and reviewed, a determination regarding your request for accommodation will be made.

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Page updated: 06-Mar-2008

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Office of Disability Services
The University of North Carolina at Greensboro
Suite 215 EUC
Greensboro, NC 27402-6170
VOICE 336.334.5440
FAX 336.334.4412
EMAIL ods@uncg.edu