Accommodation Letter Request Form printable pdf download

L E H M A N

C O L L E G E

_____________________________

The City University of New York

Accommodation Letter Request Form

Students registered with the Office of Student Disability Services notify their professors

of their disability related accommodation needs when they present them with

Accommodations Letters signed by the Director of Student Disability Services.

Students with disabilities are advised to request and present theses letters during the

first week of each new semester so that accommodations can be provided in a timely

manner. When students present their Accommodation Letters to their professors, they

should also discuss the provision of accommodations. Students are advised to make

an appointment with their professors in order to discuss their accommodations. For

example, students receiving testing accommodations must discuss where testing will

occur and whether a test is needed in an alternate format. (i.e. large print, audio tape,

etc.) If students have any concerns or difficulties with the provision of accommodations,

they should contact the Office of Student Disability Services.

Student Name: _________________________________________________________

Address: ______________________________________________________________

E-mail address _________________________________________________________

Please list classes, sections, and professor’s names:

Semester _______________

1. Class: ______________ Section: __________ Professor: __________________

2. Class: ______________ Section: __________ Professor: __________________

3. Class: ______________ Section: __________ Professor: __________________

4. Class: ______________ Section: __________ Professor: __________________

5. Class: ______________ Section: __________ Professor: __________________

Date Letters Requested: ________________________________________________

Dates Letters Received: _________________________________________________

Student’s Signature: ____________________________________________________

Office of Student Disability Services

Phone 718-960-8441

Fax 718-960-7489

250 Bedford Park Boulevard West

Bronx, N.Y. 10468-1589

Shuster Hall, Room 238

Accommodation Letter Request Form