Request for Faculty Letters - Deaf & Hard of Hearing

All requests must be reasonable and supported by appropriate documentation.

Please fill out the fields below.

Red asterisks indicate fields that are required for submission.

Student Information

I give permission to have my letter(s) emailed directly to the faculty member. I understand that a copy will be emailed to me as well to facilitate communication between myself and the faculty member regarding the methods of assessment/instruction included in the letters.
I do NOT give permission to have my letter(s) emailed. I will pick up my letter(s) from the Access Office.

Individual Course Information

Complete the following information and check the selections for EACH CLASS. Fill in additional information (e.g. class locations) as indicated. 

Course #1

Sign Language Interpreter
Notetaker

If a interpreter/ notetaker requested, please include the following.

Copies of Peer Notes
Preferential Seating
Closed Captioning of Audiovisual Materials
Assistive Listening Device
Extended Testing Time
Reduced Distraction Testing Environment
Use of a Dictionary
Other

Scroll down to continue adding additional courses below, or skip to the bottom to sign and submit.

Course #2

Sign Language Interpreter
Notetaker

If a interpreter/notetaker requested, please include the following.

Copies of Peer Notes
Preferential Seating
Closed Captioning of Audiovisual Materials
Assistive Listening Device
Extended Testing Time
Reduced Distraction Testing Environment
Use of a Dictionary
Other

Scroll down to continue adding additional courses below, or skip to the bottom to sign and submit.

 

Course #3

Sign Language Interpreter
Notetaker

If a interpreter/notetaker requested, please include the following.

Copies of Peer Notes
Preferential seating
Closed Captioning of Audiovisual Materials
Assistive Listening Device
Extended Testing Time
Reduced Distraction Testing Environment
Use of a dictionary
Other

Scroll down to continue adding additional courses below, or skip to the bottom to sign and submit.

 

Course #4

Sign Language Interpreter
Notetaker

If a interpreter/notetaker requested, please include the following.

Preferential Seating
Closed Captioning of Audiovisual Materials
Assistive Listening Device
Extended Testing Time
Reduced Distraction Testing Environment
Use of a Dictionary
Copies of Peer Notes
Other

Scroll down to continue adding additional courses below, or skip to the bottom to sign and submit.

 

Course #5

Sign Language Interpreter
Notetaker

If a interpreter/notetaker requested, please include the following.

Copies of Peer Notes
Preferential Seating
Closed Captioning of Audiovisual Materials
Assistive Listening Device
Extended Testing Time
Reduced Distraction Testing Environment
Use of Dictionary
Other

Scroll down to continue adding additional courses below, or skip to the bottom to sign and submit.

 

Course #6

Sign Language Interpreter
Notetaker
If a interpreter/notetaker requested, please include the following.
Copies of Peer Notes
Preferential Seating
Closed Captioning of Audiovisual Materials
Assistive Listening Device
Extended Testing Time
Reduced Distraction Testing Environment
Use of a Dictionary
Other

Scroll down to continue adding additional courses below, or skip to the bottom to sign and submit.

 

Course #7

Copies of Peer Notes
Preferential Seating
Closed Captioning of Audiovisual Materials
Assistive Listening Device
Extended Testing
Reduced Distraction Testing Environment
Use of a Dictionary
Other
I certify that I am the student listed above and that the information on this form is correct to the best of my knowledge.
Electronic Signature
I agree