Accommodation request form

After you have been accepted to Northwestern College, you may complete this form to request accommodations and submit documentation of your disability or medical condition. Information submitted will be treated as private and shared only with those employees responsible for ensuring your equitable access, should you enroll. Reasonable accommodations are individually determined and based on submitted information and an interview with Northwestern's accessibility specialist. If you have questions, contact Northwestern's accessibility specialist.

Personal information

Impairment information

What is the nature of the impairments for which you are requesting services?Check any that apply.
If there is more than one condition, please list them separately.
What accommodations are you requesting at Northwestern College?
Include the nature of the accommodation(s), the names of providing institutions, and the dates provided.
Please indicate the title and credential of the evaluating professional.

Documentation

Please upload documentation of your disability or medical condition from a licensed or credentialed professional with training or expertise relevant to your condition who has diagnosed or treated you within the past three years. The documentation should include:

  • Diagnosis of your disability or medical condition
  • Diagnosis date and name and credentials of the diagnostician
  • Tests, criteria and/or processes used to determine your condition
  • Educational, developmental and/or medical case history (if applicable)
  • Current functional limitations
  • Expected duration of your condition and associated limitations
  • Recommended accommodations

Please also upload a recent IEP (Individualized Education Plan) or 504 Plan if you have one.

To upload files, drag and drop files into the box or use the button below. If you prefer, documentation can instead be emailed to accessibility@nwciowa.edu or dropped off at the Student Success Center in the DeWitt Learning Commons on campus.

By submitting this form, you are initiating your request to be established as a student with a disability in accordance with federal and state regulations.