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Accuplacer Accommodations Request Form – Individual Tester

PLEASE NOTE: The following approved accommodations are only for Accuplacer.  This form does not mean you have registered with the Disability Support Services (DSS) Office.  To register with DSS, call DSS Office at 616.234.4140 or email at   An interactive discussion between a student and a Disability Support Counselor or Advisor is required before a formal Accommodations Agreement is created.

Any accommodations that you need to take the Accuplacer should be entered below.  Requests will be reviewed by a Disability Support Counselor at GRCC within 5 business days.  A GRCC representative will contact you about approved accommodations.

7 digit student ID number
Please use a current, working phone number
Please indicate your requested date here. This does not guarantee the date, but we will do our best to accommodate your request.
Choose all that apply.
This is the box to enter any other accommodations that are needed that you haven't told us about yet.

Please Submit Documentation of your Disability with this Request Form.

You can upload documentation below or:

Fax: 616-234-3622 (If you choose this option, please be sure to mark "ACCUPLACER" on the 1st page of the fax.)
US Mail to: GRCC Disability Support Services, 143 Bostwick Ave, Grand Rapids, MI 49503
Or drop off in room 368 Student Center, GRCC Campus