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All requests must be reasonable and supported by appropriate documentation.
First Name Last Name
Student ID
Student Contact [Indicate Voice, TTY, VP, or text after the number. Ex: 229-555-1212 (text)]
Student Email (Use VSU email account.)
Student Term Select a term Summer Fall Spring
Complete the following information and check the appropriate box next to the accommodations you are requesting. You will complete a separate section for EACH CLASS. Fill in additional information (e.g. class locations) as indicated.
Title Please use course abbreviation (ex: MATH 1101, NOT "Math Modeling")
Instructor
Sign Language Interpreter
Notetaker
If requesting interpreters/notetakers please include the following:
Class location
Class meets (days) n/a Monday only Tuesday only Wednesday only Thursday only Friday only Monday & Wednesday Tuesday & Thursday Monday through Friday Monday through Thursday Monday/Wednesday/Friday Saturday
Begin Time End Time
Additional accommodations:
Copies of Peer Notes
Permission to tape record lectures
Preferential seating
Closed Captioning of audiovisual materials
Assistive Listening Device
Extended Testing Time
Reduced distraction testing environment
Use of a dictionary
Copies of overheads/PowerPoint slides
Alternate Table
Alternate chair
Other (please describe):
I understand that students must pick up their accommodation letters from the Access Office, deliver them to their professors for signing, and return them to the Access Office for accommodation implementation. Checking the box below serves as an electronic signature.
I agree
When you click the "Submit" button below, a summary of your information will be displayed on the screen. Please double check this to make sure you have included all relevant information. If this summary page does not contain all of your information, or you entered information that does not show up, please contact the Access Office immediately.
