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Disability Services Request Form


Welcome to Disability Services at Roane State! Section 504 of the Vocational Rehabilitation Act of 1973, as amended, and the Americans with Disabilities Act of 1990, as amended, prohibit discrimination against individuals with disabilities.

 

The purpose of this form is to document your request for reasonable accommodation(s). In order to evaluate your request, we will need information regarding your disability, your functional limitations and your requested accommodation(s) and services.

 

This form goes to a member of our team who will reach out with next steps. MAKE SURE YOU ENTER YOUR NAME/CONTACT INFORMATION.

 

If you need assistance completing this form, please contact Sonya Storey, Director of Student Care, Advocacy, and Accessibility Services at storeysr@roanestate.edu or 865-354-3000, ext 4365.

General Information

 
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Your information

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Status & Disability Information

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What is the nature of your disability?(Required)
You must make at least one selection.
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Limited major life activity(Required)
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Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission