Request for Accommodation:
Student Information
Last Name:
First Name:
Middle Name:
(please provide if available)
Please describe the reasonable accommodations that are necessary:
(select all that apply)
Access to internet
Elevator access
Moveable seating
Wheelchair access
ACCESS will be placing an accessible table/desk into the classroom
Additional seats for care attendants/aides, CART/typewell transcribers, interpreters, etc.
Please indicate the number of additional seats needed:
1
2
3
4
5
Other - See Comments Below
Courses Requiring Accommodation:
Term:
2014 Fall
2014 Summer
2014 Spring
2013 Fall
2013 Summer
2013 Spring
2012 Fall
2012 Summer
2012 Spring
2011 Fall
2011 Summer
Please cut and paste course details directly from the enrollment report.
(for example: GERM 237 19th-Century Prose 14439 A LEC M 16 7 09:35 10:25 M W F WATERM 419)
The course
subject, number, and meeting pattern
must be included in order for us to process your request. Link to the appropriate term here:
Spring
Summer
Fall
Course A:
Course B:
Course C:
Course D:
Course E:
Course F:
Course G:
Course H:
Additional Comments:
ACCESS Contact Email: