Deaf and Hard of Hearing Accomodation Request Form

List all courses for which you are requesting accommodations.

Student Information
Your Name:	Best way to contact you:
Your UVM email:	Student ID (95#######):
Your NetID:

Semester Needed

Term Fall Winter Spring Summer

Year 2009 2010 2011 2012

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Additional Information:

By submitting this form, I agree to the following -

• I will submit this online request form each semester so that ACCESS can set up my accomodations.
• I will submit Accommodation Letters for each course, to each professor for each semester so that faculty and staff can coordinate the provisionof requested accommodations.
• I will notify ACCESS immediately of any changes to my schedule, including:
• When I add or drop a course.
• When the class time changes.
• When the class location changes.
• When I no longer need an accommodation.
• When I find out about an additional class time, labs, field trips, study sessions, supplemental instruction or exam review sessions.

Click to send your request.
Click to clear the form

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