Raritan Valley Community College
Disability Services Office

ACCOMMODATION REQUEST FORM

Winter	Spring	Summer I	Summer II	Summer III	Fall
SEMESTER: Circle one					YEAR: 200__

I would like to receive the reasonable accommodations that have been approved for me this semester.
I understand and accept the following:

This request is only good for this semester;
I must submit a request each semester;
I will self-identify to each of my professors during the first week the class meets;
I will hand-deliver the Accommodation Letter as soon as it is available to me;
I will return a copy of the letter with the professor’s signature and date, to the Disability Services office, after delivering it; or
I will sign and date the letters with "Did not use", if I choose not to request accommodations in certain courses.

If I choose not to self-identify or to give the professor the Accommodation Letter in a timely fashion, then I risk not receiving the accommodations that may be needed for assignments or for test-taking.

Thank you for your consideration of my request.

NAME:______________________________ ID:________________________

Signature:____________________________ DATE:_____________________

Please submit form to the Disability Services office after you have registered.

5/21/2004 L.W.B.

Raritan Valley Community College Disability Services Office

ACCOMMODATION REQUEST FORM

Raritan Valley Community College
Disability Services Office