Delgado CC - Semester Accommodation Request Form

First Name*

Last Name*

LOLA Number*

Which semester are you requesting accommodations for?*

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?

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 1Please 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 2Please 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 3Please 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 4Please sign your initials.

Header Two

Semester Accommodation Request Form