Request for Faculty Letters

Please fill out the fields below.

Red asterisks indicate fields that are required for submission.

Semester/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 the letter(s) from the Access Office.
Individual Course Information

Complete the following information and check the appropriate box selection for EACH CLASS.  Fill in additional information (e.g. percent extended time, class locations) as indicated. 

Please note, if you are requesting materials in alternate format, an Alternate Media Request Form (available in Word format on the Access Office forms page) must be completed and submitted separately.

Course #1

Extended Testing Time
Reduced Distraction Testing Environment
Use of a Word Processor
Access to Lecture Notes
Assistance of a Scribe
Use of a Hand-held Spell Checker
Use of a Dictionary
Adaptive Table/ Chair
Preferential Seating
Text Materials in Alternate Format
Other

Continue adding courses below or skip to the bottom to sign and submit.

Course #2:


Extended Testing Time
Reduced Distraction Testing Environment
Use of a Word Processor
Access to Lecture Notes
Assistance of a Scribe
Use of a Hand-held Spell Checker
Use of a Dictionary
Adaptive Table/Chair
Preferential Seating
Text Materials in Alternate Format
Other

Continue adding courses below or skip to the bottom to sign and submit.

Course #3:


Extended Testing Time
Reduced Distraction Testing Environment
Use of a Word Processor
Access to Lecture Notes
Assistance of a Scribe
Use of a Hand-held Spell Checker
Use of a Dictionary
Adaptive Table/ Chair
Preferential Seating
Text Materials in Alternate Format
Other

Continue adding courses below or skip to the bottom to sign and submit.

Course #4:


Extended Testing Time
Reduced Distraction Testing Environment
Use of a Word Processor
Access to Lecture Notes
Assistance of a Scribe
Use of a Hand-held Spell Checker
Use of a Dictionary
Adaptive Table/ Chair
Preferential Seating
Text Materials in Alternate Format
Other

Continue adding courses below or skip to the bottom to sign and submit.

Course #5:

Extended Testing Time
Reduced Distraction Testing Environment
Use of a Word Processor
Access to Lecture Notes
Assistance of a Scribe
Use of a Hand-held Spell Checker
Use of a Dictionary
Adaptive Table/ Chair
Preferential Seating
Text Materials in Alternate Format
Other

Continue adding courses below or skip to the bottom to sign and submit.

Course #6:

Extended Testing Time
Reduced Distraction Testing Environment
Use of a Word Processor
Access to Lecture Notes
Assistance of a Scribe
Use of a Hand-held Spell Checker
Use of a Dictionary
Adaptive Table/ Chair
Preferential Seating
Text Materials in Alternate Format
Other

Continue adding courses below or skip to the bottom to sign and submit.

Course #7:

Extended Testing Time
Reduced Distraction Testing Environment
Use of a Word Processor
Access to Lecture Notes
Assistance of a Scribe
Use of a Hand-held Spell Checker
Use of a Dictionary
Adaptive Table/ Chair
Preferential Seating
Text Materials in Alternate Format
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.

I Agree