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Academic Support Programs

Student Application for Temporary Services

Student Application for Temporary Services


Demographic Data

Name:

Date:
Student ID (95#######):
Local Address (Street, City, State, Zip Code):
Phone (Cell):
Your UVM email:

Disability Information

1. Please identify your temporary mobility issue.

2. Please identify any other issues or concerns impacting your academic performance.

Test Accommodations (Please describe)

Note-taking Assistance (Please describe)

Other:


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Last modified April 09 2010 08:59 AM

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