ARC Affiliation Form

Student Information

By completing this form you are notifying TCNJ that you may be requesting reasonable accommodations on the basis of disability.

Please note that this form can only be filled out once. If you were previously affiliated with ARC and have questions about next steps, please contact ARC at arc@tcnj.edu.

First Name

Last Name

Middle Name

Preferred Name

Pronouns

PAWS ID

TCNJ Email

Please use your TCNJ email address if known, if not, then other email

Cell Phone

Other Phone

Anticipated graduation date

Are you the first person in your family to attend college?

Are you in the military or are you a veteran?

Are you a non-degree student?

Are you a transfer student?

Are you attending TCNJ for summer session(s) only?

Do you live or will you be living on campus?

Disability/Diagnostic Information

Select your disability

Choose all that apply

Other, please specify

Describe how your disability affects you both outside and inside the classroom, including exam and studying situations

Check any of the Life Activities listed below that you believe are affected as a result of your diagnosed condition(s)

Choose all that apply

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List any other condition(s) affecting school that you would like to discuss

Have you received accommodations previously?

Accommodation Information

What accommodations will you be requesting at TCNJ?

The requirements for providing accommodations at the college level differ significantly from those for high school. Please be aware that you may not receive all of the accommodations you have had in the past.

Are you interested in participating in individualized weekly skill building meetings with the Lions Plus Program?

If "yes", an ARC representative will contact you with information about the TCNJ's Lion Plus program. The Lions Plus Program is a fee based program which is in addition to any approved accommodations.

Will you be requesting, or are you interested in discussing, on-campus housing accommodations?

If you are applying for housing accommodations, please indicate move-in date

Do you have any questions at this time?

Upload supporting document(s)

Click here to view documentation guidelines.

Agreement

By signing below, I am certifying that I am, in fact, the student requesting accommodations through the Accessibility Resource Center

ARC Affiliation Form

Student Information

Disability/Diagnostic Information

Accommodation Information

Document Information