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Accommodation Request Form


Students may request reasonable accommodations as a result of a qualifying disability as defined by Federal legislation within the Americans with Disabilities Act (1990), the Americans with Disabilities Amendments Act (2008), or Section 504 of the Vocational Rehabilitation Act (1973). If you are an employee at Davenport, please contact Human Resources to begin your process.

This form will go directly to a Student Access staff member once completed. 

Student Information

 
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Involved Parties

Involved party 1

Questions

Information provided to Davenport will help the University work with students to plan effective academic accommodations and auxiliary aids and services while enrolled. All information provided on a voluntary basis by a student shall be used for the sole purpose of assessing the accommodation request(s).

Please select your area of study:(Required)
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General Nature of the Disability or Impairment. Please check all that apply:(Required)
You must make at least one selection.
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I understand that a Verification of Disability Form, or similar document completed by a medical professional, is required for each disability or impairment for which accommodations are requested.(Required)
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Supporting Medical Documentation

Please attach the completed Verification of Disability Form, or similar medical documentation, here. This could include a IEP or 504 Plan. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission