Intake Form

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Student Information

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All faculty, staff and students are expected to check their TCC email on a frequent and consistent basis in order to ensure that they are staying current with all official communications.
Which pronouns would you prefer?
ie: Fall 2021, Spring 2022
Are you a Dual Enrollment student?

Please answer Yes if you are a current high school student planning on taking TCC classes either at TCC or at your high school.

Disability
Please check all that apply
Please describe any support services or devices you have used in previous academic settings.
Have you experienced difficulty in any of the following academic areas?
Check all that apply
Are you receiving services from any of the following agencies?
Check all that apply
Upload supporting document(s)

Each student will be interviewed in an intake process. Academic accommodations will be provided on an individual basis and will be based on the student's functional limitations. IEPs and 504 Plans are helpful to colleges but may be insufficient as a sole form of documentation. The documentation needed is an evaluation conducted by a qualified professional with training and experience in evaluating adolescent/adult populations. (Evaluators include clinical psychologists, neuro-psychologists, psychiatrists, or other relevantly trained medical doctors. A clinical team approach to diagnosis may also be appropriate.)

For more detailed information on our documentation guidelines please visit our webpage: Documentation Guidelines

If you are not registered to vote where you live now, would you like to apply to register to vote here today? Required

If you do not check any box, you will be considered to have decided not to register to vote at this time. Applying to register to vote or declining to register to vote will not affect the assistance or services that you will be provided by this agency. 

If you decline to register to vote, this fact will remain confidential. If you do register to vote, the office where your application was submitted will be kept confidential, and it will be used only for voter registration purposes. 

If you would like help filling out the voter registration application form, we will help you. The decision whether to seek or accept help is yours. You may fill out the application form in private if you desire. 

If you believe that someone has interfered with your right to register or to decline to register to vote, your right to privacy in deciding whether to register or in applying to register to vote, you may file a complaint with: 

Commissioner, Virginia Department of Elections Washington Building
1100 Bank Street
Richmond, VA 23219-3497 (804) 864-8901 

For more information:

 Virginia Voter Registration Information

National Voter Registration Information

Information contained with the file will be kept confidential and will not be shared with anyone outside TCC without your expressed authorization. The college requires that this form and appropriate documentation of disability be submitted 30 days prior to receiving the appropriate accommodations. Once the intake is complete and submitted you may schedule an appointment with the Educational Accessibility Counselor on your campus of choice to discuss accommodations, procedures, and policies.