NOTE: Do not attempt to complete this form before carefully reading "How to Request an Accommodation for a Disability" If you have questions on this form, please contact VLS's 504 Coordinator, Vice Dean Joe Brennan at firstname.lastname@example.org.
Please upload all documentation required under the pertinent documentation guidelines.
(Documentation Guidelines available here)
Accommodation(s) requested: (check all that apply)
Special exam answer format (e.g. computer only, handwritten only, large print, voice-to-text, etc.)
Additional time for in-class, timed exams
Private exam room
Special Seating Arrangements (e.g. sit/stand requirements, front row requirements, etc.)
Electronic texts and/or text-to-speech readers
Notetaker Services/Class Recordings
Other (please specify):
a. Did you receive formal accommodations while you were in college or in other recent academic setting? Yes No
b. Have you received accommodations for standardized tests such as the SAT, LSAT, GRE or GMAT?
c. Have you received accommodations at a place of employment?
d. If you answered "Yes" to any questions above, please describe and upload any relevant documentation:
e. If you answered "No" to all questions above, please state why you are requesting accommodations today:
The information you enter here is retained by VLS for internal use, and may be submitted to third-party tools or entities for specific, related purposes such as payment processing or reporting. All data is collected and retained via secure protocols. Click here to read relevant policy information.European Union residents, click here to request removal of your data from our systems.
Please check this box to indicate that you understand the data retention policy information.