Student Accessibility Services - REQUEST FOR ACADEMIC ACCOMMODATIONS

Your Information

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Your full name:

Your Student ID#:

Your phone number:

Your email address:

Email address must be of a valid format.

Your Expected Year to Graduate:

Location of Courses(Required):

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Course Information

Which semester are you requesting accommodations for?(Required) This field is required.

Please provide the following information below for each course you are requesting accommodations for: 1) Course name and number (e.g. Biology 13), 2) Section number, 3) Instructor name and email, 4) Accommodation requested, 5) Assistive technology needed.(Required) This field is required.

Is this request in reference to an online course(s), a face-to-face course(s), or both?(Required)

Online Face-to-face Both

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Please type your initials below. By doing so, you certify that you are the person for whom academic accommodations are being requested, and you confirm that all information you have provided is accurate.(Required) This field is required.

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Your Information

Course Information

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