Application for Academic Accommodations

* indicates a required field

Section I: Student Information

Please provide us with your contact information requested below. Please make sure that your phone number and email are clearly inputted, so that we have the information we need to contact you. The EMPL ID is a number assigned to each student that is accepted to a CUNY college and can be found in CUNYFirst or on your CUNY ID card. If you are unable to obtain this number, please enter Unknown for that line.

If you do not have a CUNY ID (EMPL ID) number please enter zeros.
Date of Birth Required
Last 4 digits only
Street & Address
Please use your CUNY email address, if you do not have one, please list your personal email here and below.
Please add a personal email address that we can use to contact you. This is especially important if you do not have a Kingsborough email set up yet.
Would you need physical assistance to be evacuated during an emergency? Required

Section II: Education Information

For this section we would like to know your Major and your status as a Kingsborough student, please check off all that apply.

Section III: Disability Related Information

For this question we would like to know what type of disability you are identifying as the basis for requesting accommodations while studying at KCC. Please insure that the supporting documentation you submit also indicates the type of disability you check off for this question. This information will be kept strictly confidential.
Check all that apply:
The purpose of this question is to help us figure out if you would benefit from specific accommodations, if none of these apply then please move to the next question.
Medications may sometimes impact your functioning in certain areas. If you are currently taking any disability-related medication that you wish to disclose, please list the medications.
Check off the tasks that you CAN do easily Required
Check off the tasks that you have difficulty with because of your disability Required

This section is very important, here is where you get to indicate which accommodations you would like to request while attending Kingsborough Community College. Our office can only approve accommodations that you request and will not consider accommodations listed on your supporting documentation unless they are also listed here.

This question is required. Please contact AAS if you need help with this question.

If you are a transfer student from another college, please list both the college(s) you attended and the accommodations that you received:

Section IV: Agency Information

The below question asks about agencies that are outside of Kingsborough CC and support students with disabilities financially. We would like to know if you are a part of these programs in order to help you receive the most support possible. If you do not recognize any of these agencies, you can leave this question blank.

Do you receive services from any of the following agencies?

Section V: Other Services

Below you will find information about other programs/services available to you as a student and as a person with a disability, please check yes if you are interested in learning more about these programs/services.

National Voter RegistrationRequired

This office is a National Voter Registration site. If you are not registered to vote where you live now, you may apply to register to vote here. If you would like help in filling out the voter registration form, this office will assist you. You may fill out the application in private. Deciding whether or not to register to vote is up to you and will not affect the services you receive from AAS. Would you like to apply to register to vote?


CUNY LEADS is a program established to facilitate successful academic and career outcomes for CUNY students with disabilities. LEADS is an optional program that is FREE for any student with a documented disability enrolled in a CUNY program.

CUNY LEADS services include: 

  • Academic Counseling, Goal Setting & Self-Advocacy Skills 
  • Career Counseling & Life Coaching 
  • Resume & Job Search Preparation 
  • Volunteer & Internship Exploration 
  • Referrals for Tutoring, Scholastic and Health Service Supports, Benefits & Entitlements 
  • ACCES-VR Assistance 
  • Senior College Transfer Assistance 
Are you interested in CUNY LEADS?Required
TRiO Student Support Services

TRiO Student Support Services is a student support program, conveniently located in Room D205, the same suite as AAS. It is optional program available to students registering with AAS and who are U.S. citizens or permanent residents.

In partnership with AAS, TRiO helps students to persist so that they stay in college and earn an associate degree. TRiO services include, but are not limited to:

  • One-on-one and mini-group tutorials 
  • Academic and career counseling 
  • Academic Advising 
  • Assistance with financial aid and financial literacy 
  • Technology skills 
Are you interested in being considered for TRiO? Required

Section VI: Policy on Confidentiality

General Rule: 

Access-Ability Services is required by law to maintain student confidentiality. All requests for accommodations and all supporting information are considered confidential.

The Family Educational Rights Privacy Act (FERPA) regulates how Access-Ability Services discloses the documentation and records that the office maintains. Under this federal act, the student must provide written consent before Access-Ability Services can release any disability documentation or records. 

An Exception to the Rule:

Under FERPA, Access-Ability Services is permitted to release information to any college official who has a “legitimate educational interest.”

What does this mean?

A college official, acting in the student's educational interest, who needs the information for administrative, counseling, supervisory, academic, or student support purposes may request student information from AAS. AAS will only share information on a “need-to-know” basis. The office will carefully consider the student’s desire for privacy before disclosing any information.

FERPA also allows students to inspect and review their files maintained by AAS. Students have the right to challenge any information contained in the files that is incorrect or misleading and to request an amendment to this misinformation. 

Upload supporting document(s)

Uploading Documentation Will Make Sure That There Are No Delays in The Processing of Your Application


While documentation helps to support your request for accommodations we understand that you may not have access to appropriate documentation or have not had the opportunity to obtain documentation from an appropriate source.

Should you submit this application without supporting documentation, our office will reach out to you at the contact information you provided on this application to schedule an appointment with our counselor that reviews the applications. Please look for an email from or a call from our office. We will not be able to process your request until after you have met with our counselor. You can also make an appointment with our counselor by emailing or by calling 718-368-5175.

Submitted documentation should:

  • Be provided by a qualified professional with expertise in the specific disability.
  • Include the professional’s name, title, and professional credentials including state licensure or certification number.
  • Be signed by the professional responsible for the documentation.
  • Include the date of when the letter was written.
  • Contain diagnostic information. Please note: mental/emotional disabilities must be accompanied by a numerical DSM-V TR classification code. All other diagnostic classification codes should be from the ICD-10.
  • Be current. Disabilities may change in nature and severity over time and documentation should support current accommodation needs.
  • Include recommendations and rationale for accommodations that are based on an analysis of how the diagnosis impacts the student’s current functioning.

Section VII: Signature

I have completed the Application for Accommodations as thoroughly and accurately as possible. I have read and understand Access-Ability Services’ policy on confidentiality

Please type your name