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.

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 (50%)
Extended Testing Time (100%)
Reduced Distraction Testing Environment
Use of a Word Processor
Record Lectures
Copies of Power Points
Peer Notes
Use of a Dictionary
Preferential Seating
Accessible Table
Accessible Chair
Textbooks in Alternate Format (If you have not already done so, you will need to request textbooks in alternate format using the button on the Access Office page)
Other Text Materials in Alternate Format (ex: handouts)
Course Attendance (Please note that Faculty need to be consulted to determine reasonable accommodation for the particular course. This may take the Access Office additional days to establish. Please contact the Access Office if you have not received your copy of the Faculty Letter within five business days.

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

Course #2:

 
Extended Testing Time (50%)
Extended Testing Time (100%)
Reduced Distraction Testing Environment
Use of a Word Processor
Record Lectures
Copies of Power Points
Peer Notes
Use of a Dictionary
Accessible Table
Accessible Chair
Preferential Seating
Textbooks in Alternate Format (If you have not already done so, you will need to request textbooks in alternate format using the button on the Access Office page)
Other Text Materials in Alternate Format (ex: handouts)
Course Attendance (Please note that Faculty need to be consulted to determine reasonable accommodation for the particular course. This may take the Access Office additional days to establish. Please contact the Access Office if you have not received your copy of the Faculty Letter within five business days.

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

Course #3:

 

 
Extended Testing Time (50%)
Extended Testing Time (100%)
Reduced Distraction Testing Environment
Use of a Word Processor
Record Lectures
Copies of Power Points
Peer Notes
Use of a Dictionary
Accessible Table
Accessible Chair
Preferential Seating
Textbooks in Alternate Format (If you have not already done so, you will need to request textbooks in alternate format using the button on the Access Office page)
Other Text Materials in Alternate Format (ex: handouts)
Course Attendance (Please note that Faculty need to be consulted to determine reasonable accommodation for the particular course. This may take the Access Office additional days to establish. Please contact the Access Office if you have not received your copy of the Faculty Letter within five business days.)

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

Course #4:

 

 
Extended Testing Time (50%)
Extended Testing Time (100%)
Reduced Distraction Testing Environment
Use of a Word Processor
Record Lectures
Copies of Power Points
Peer Notes
Use of a Dictionary
Accessible Table
Accessible Chair
Preferential Seating
Textbooks in Alternate Format (If you have not already done so, you will need to request textbooks in alternate format using the button on the Access Office page)
Other Text Materials in Alternate Format (ex: handouts)
Course Attendance (Please note that Faculty need to be consulted to determine reasonable accommodation for the particular course. This may take the Access Office additional days to establish. Please contact the Access Office if you have not received your copy of the Faculty Letter within five business days.)

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

Course #5:

Extended Testing Time (50%)
Extended Testing Time (100%)
Reduced Distraction Testing Environment
Use of Word Processor
Record Lectures
Copies of Power Points
Peer Notes
Use of a Dictionary
Accessible Table
Accessible Chair
Preferential Seating
Textbooks in Alternate Format (If you have not already done so, you will need to request textbooks in alternate format using the button on the Access Office page)
Other Text Materials in Alternate Format (ex: handouts)
Course Attendance (Please note that Faculty need to be consulted to determine reasonable accommodation for the particular course. This may take the Access Office additional days to establish. Please contact the Access Office if you have not received your copy of the Faculty Letter within five business days.)

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

Course #6:

Extended Testing Time (50%)
Extended Testing Time (100%)
Reduced Distraction Testing Environment
Use of Word Processor
Record Lectures
Copies of Power Points
Peer Notes
Use of Dictionary
Accessible Table
Accessible Chair
Preferential Seating
Textbooks in Alternate Format (If you have not already done so, you will need to request textbooks in alternate format using the button on the Access Office page)
Other Text Materials in Alternate Format (ex: handouts)
Course Attendance (Please note that Faculty need to be consulted to determine reasonable accommodation for the particular course. This may take the Access Office additional days to establish. Please contact the Access Office if you have not received your copy of the Faculty Letter within five business days.)
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