Self-Disclosure Form for Requested Student Services

Western Suffolk BOCES/Wilson Tech welcomes all learners to our Adult Education programs and will provide enrolled/registered students with disabilities with services and accommodations upon request. Please note that all requests for services and accommodations should be made 30 days in advance of the first session. Please also note that Western Suffolk BOCES/Wilson Tech reserves the right to cancel any courses/programs at any time before the first session for enrollment, staffing or other reasons.

Adult Students who have enrolled in classes at Western Suffolk BOCES/Wilson Tech and who wish to receive information about services and accommodations for students with disabilities should complete this form. You must complete this form even if you have already disclosed this information directly at any of the school locations.

When we receive this completed self-disclosure form, a person from the agency dedicated to assist you will contact you to answer any questions and to set up an intake. You must submit current official documentation of disclosed disabilities. Western Suffolk BOCES can take no action on your behalf without your specific request and/or without your complete information and documentation.

If you have difficulty submitting this form, please call 631-667-6000 ext 152 between 9 am and 3 pm on business days.