Request for Accommodation

* = Required
This question is required
This question is required
This question is required
This question is required
This question is required
This question is required
Your Degree Level of Study *
Undergraduate
Graduate
Doctoral
This question is required
This question is required
I am voluntarily identifying my disability as it is related to *
Learning
ADHD
Psychological
Medical
Physical
Vision
Hearing
Other
This question is required
Classroom
Enlarged course material
Permission to audio record class lecture material
Assistance with note taking
American Sign Language interpreting services
Flexible attendance in face-to-face classes
Other
Testing
Separate room, or reduced-distraction environment in which to take the test
Extended time beyond the standard for completion
Use of spell check device
Use of calculator
Reader for tests
Other
Additional Services (See Learning Support Specialist)
Assistance with obtaining (required) books in alternative formats
Assistive technology (please explain)
Other (please explain)
This question is required