Request for Academic Adjustment and/or Auxiliary Aid

Academic adjustments and/or auxiliary aids are provided for qualified students on an individualized basis according to the specialized needs of each student and the availability of equipment, service providers, and funding. Services may include (but are not limited to) one or more of the services listed below. Please indicate the academic adjustment and/or auxiliary aids you are requesting along with your current semester schedule.

Please complete by checking all that apply and providing detail when needed:

If you prefer, you may fill out and print the paper form here and return to the Disabilities Services Coordinator in Wilson Building, Room C1041A.

Name:

Semester requesting service:   Year:

Classroom Assistance
Note-Taker Tape-record lectures Sign language interpreter
Other:

Testing Accommodations
Extended time* Distraction free room Reader
Scribe Large print Other:

Enlarged materials
Class Syllabus Class handouts Tests
Other:

Reader Assistance

Other:

* Extended time does not mean unlimited time. No more than 2 times the regular allotted time may be granted.