OSS Request Form

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OSS Request Form
Services for People with Disabilities

Bergen Community College is both pleased and fortunate to be an educational institution accessible to students with disabilities. The Office of Specialized Services serves students with physical, visual, learning, hearing and psychiatric disabilities.

To take advantage of these services, fill in the form below and send it to the Office of Specialized Services. Disclosure is voluntary, but must be made if services are to be provided in a timely manner.

For further information, call the office at (201) 612-5270 or (201) 447-7845 (TTY) or visit us in Room S-131. Please indicate the type of disability you have, and return this postcard to us so that we may send you information.

Check all that apply

Wheelchair mobile	Speech Impairment
Visual Impairment or Blindness	Cardiac Condition
Use of braces or crutches	Seizures (Epilepsy)
Neurological Impairments	Learning Disability (polio, cerebral palsy, stroke, etc.)
Hard of Hearing	Deafness
Other (describe)

Name:
Email:
Address:
City:
State:
Zip:
SSN Number:
TTY Number:


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