Apply for Services

Have you been accepted to UNCP?

Yes

First Name

Middle Initial

Last Name

Banner ID if current student

This is your unique ID number and consists of 9 digits

Are you registered to vote?

Yes

Are you a veteran?

Yes

UNCP Email (only)

Confirm email

Phone (Home)

Phone (Cell)

Address

City/Town

State/Province

ZIP/Postal Code

Country

Date of Birth

Program of study

Year of enrollment / Program start

Anticipated year of graduation / program completion

Education Classification

Undergraduate

Graduate/Professional

Continuing Studies

Distance Education

How did you learn about ARC Services (for example, Admissions, Orientation, Professor, Course Syllabus, another Institution, etc.)

Primary Type of Disability/Medical Condition

Attention Deficit Hyperactivity Disorder

Chronic Medical Condition

Hearing Impairment

Learning Disability

Physical/Mobility Impairment

Psychological/Psychiatric

Visual Impairment

Other…

Associated Limitations

Concentration/Thinking

Hearing

Seeing

Reading

Speaking

Understand Spoken Language

Walking/Climbing Stairs

Writing

Type of Disability

Temporary

Permanent

Please list any additional disabilities

Historical Impact - In as much detail as possible, please describe how your impairment has affected your life in the past?

Have you used resources, services and accommodations in the past? If 'yes' please give as much information as possible.

Semester for which accommodations are being requested / or to start:

Summer

Fall

Spring

Year (specify)

My Current Impact Statement and Accommodations Requested:

Please use this box to tell us how the diagnosed disability / medical condition described is currently impacting your functioning and causing you substantial limitations. 1. Considering the skills such as reading, writing, paying attention, mathematics, etc., describe (be specific) the current (or recent) impact of the disability/medical condition in both of the following areas: a. In Class - lectures, labs, test-taking, participation, etc. b. Out of Class - private study, time management, homework, daily living and accommodation/residence needs etc. 2. Accommodations/Services With reference to the above information, describe the accommodations, resources and services that you think you will need and how these will address the issues you have identified above. If a written response is difficult for you, you may record your responses and submit an audio file.

Documentation

Please review the Guidelines for Documentation

Upload documentation if available electronically 1

Click 'Choose file' then browse to your Documentation file and select then click 'Upload' The documentation submitted should be from a professional who is licensed/certified in the area for which the diagnosis is made and who is not related to the student. The documentation must be presented on practice letterhead and signed by the examiner. We encourage you to upload the documentation file below if it is available electronically as this will speed up our review process. However, if your documentation is not available electronically or if you prefer, you may mail the documentation to Accessibility Resources Center, University of North Carolina Pembroke, PO Box 1510, Pembroke, NC 28372 or send by fax to 910-521-6891.
One file only.
24 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, ppt, pptx, xls, xlsx.

Upload documentation if available electronically 2

Click 'Choose file' then browse to your Documentation file and select then click 'Upload'
One file only.
24 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, ppt, pptx, xls, xlsx.

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Accessibility Resource Center

Accessibility Resource Center

The University of North Carolina at Pembroke