Please complete this information for every course you are registered for and requesting accommodations; incomplete or inaccurate information may delay the process.

Semester *
Year *

Class 1

Class 2

Class 3

Class 4

Class 5

Class 6

Please note:
-Accommodations are processed on a first-come, first-served basis. Some accommodations may take up to 4 weeks to arrange.
- If you make changes to your schedule, you must complete a new form.
- If you are requesting changes to your existing accommodations, you must complete a new form.
- Once your accommodation request is reviewed, you will receive an email with the decision.
- Accommodations are not retroactive. Approved accommodations will be effective from the date of the accommodation approval.
- Instructors will receive an accommodation letter, detailing approved accommodations via email by the Office of Disability Services.

By submitting this form, you certify that you are the student named above, requesting accommodations from the Prairie State College, Office of Disability Services.

Date: Monday, 23 July 2018 (EDT)
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