Disability Intake Form

This form is designed to help us begin assessing the needs of students with temporary and permanent physical, psychological, and learning disabilities so that we can provide effective accommodations in a timely fashion. If you have a disability, please complete the following questions so that the college will have an idea of the services you may need.

If you have not been evaluated in the past three years, or if you require an initial evaluation, please contact the following offices for information and referral: Medical evaluations: contact Health Services at (812) 866-6102. Psychological evaluations: contact Counseling Services at (812) 866-6740.

All information disclosed on this form will be kept confidential according to federal guidelines and will be shared with appropriate college personnel on a need-to-know basis only.

If you experience any problems in trying to upload your supprting documentation, please email your files to stokes@hanover.edu.

If not submitting electronically, please send a copy your documentation to the Disability Services Coordinator at P.O. Box 890, Hanover College, Hanover, IN 47243.

I release this information to the appropriate faculty and staff on a need-to-know basis.