Acknowledgment and Consent Statement
I acknowledge and understand that any accommodation(s) requested will be determined by the College. To assist the Coordinator for Disability Support Services, I hereby consent to the release of any information contained herein---or any information provided to the College---regarding my disability to the Disability Support Services Coordinator, designee of the Disability Support Services Coordinator, or other College staff, as appropriate, in order to make determinations or reasonable accommodation(s).