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

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.
- 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: Tuesday, 7 February 2023 (EST)
Name:
Type your name to sign this document:
Typing name is equivalent to a handwritten signature
Signature