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Header Two
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Student Services
Advising
Disability Services
Forms
Semester Accommodation Request Form
Semester Accommodation Request Form
If you see this don't fill out this input box.
First Name
*
Last Name
*
LOLA Number
*
Which semester are you requesting accommodations for?
*
Please Select
Fall 2020 (Full Term)
Spring 2021 (Full Term)
Number of Letters Requested
Which campus or campuses are you attending?
City Park Campus
West Bank Campus
Jefferson Site
Sidney Collier Site
Charity School of Nursing
River City Site
Your Email Address
*
How would you like to receive your letter of accommodation?
Emailed
Will pick up at the Office of Disability Services
What kind of assistance are you requesting?
American Sign Language Interpreter
Captionist
Note-Taker
Read each line carefully and provide your initials for each line.
Line 1:
I understand that it is my responsibility to notify the Disability Coordinator of any changes to my class schedule immediately.
Response to Line 1
Please sign your initials.
Line 2:
I understand that if I do not plan to attend a class that has a scheduled Interpreter or Captionist, I will notify the ODS Coordinator and Service Provider at least 24 hours in advance prior to the beginning of class via text, email, or telephone.
Response to Line 2
Please sign your initials.
Line 3:
I understand the Interpreters, Captionists, or Note-Takers that are assigned to my class will leave 15 minutes after the instructor starts class if I am not in attendance, and I will be marked as a "No Show" for that class.
Response to Line 3
Please sign your initials.
Line 4:
I understand that after three documented consecutive "No Shows" for the semester, my services will be temporarily suspended until I meet with my Disability Service Coordinator.
Response to Line 4
Please sign your initials.
Form UUID
Site Name
Submit
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