Office of Student Accessibility Services

Student Schedule Request

This form needs to be updated and submitted to the Office of Student Accessibility Services prior to each semester of enrollment and 3-4 weeks in advance for arrangement of accommodations such as scheduled services, auxiliary aids or alternative materials. Please include only the faculty/staff you would like informed of your accommodations. If the schedule, instructor, or involvement in non-academic services change during the semester please complete this form again.

For changes to your previous accommodations you will need to meet with the Coordinator in advance. Remember, you are responsible for meeting with your instructors at the beginning of the semester. The Coordinator will email you when your plan has been sent to your instructors.

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Fields with an asterisk (*) are mandatory.

General Information

Full Name*


*This form requires one course or one group. All input fields are required for each course. If the instructor is unknown, put "Unknown" instead.

Course 1

Group(s) & Organization(s)

*This form requires one group or one course. All input fields are required for each group. If the group contact is unknown, put "Unknown" instead.

Group 1


By completing and electronically signing this form, you are giving the Office of Student Accessibility Services permission to send accommodation notice sent to all listed parties above. You acknowledge that you understand accommodations are only provided to those faculty and staff listed on this form and when/if staff need the information to implement accommodations. You understand this form applies only for the term and faculty/staff as listed.