Semester Accommodation Request Form

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

How would you like to receive your letter of accommodation?

Emailed

Will pick up at the Office of Disability Services

If you are requesting a Communication Facilitator (CF) in the classroom, please make a selection below:

American Sign Language Interpreter

Captionist

Note-Taker

select as many as needed

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.

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.

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.

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.