Accommodations for Students with Disabilities - University of Maine at Fort Kent

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Accommodations for Students with Disabilities

Accommodations must be requested by the student prior to the beginning of each semester. Accommodations are not automatically renewed. Specific accommodations are determined on the basis of the nature of the disability and the requirements of each course.

Name:		Date of Birth:
Address:		Phone:
Address 2		Email:

I am requesting the following accommodations in the course(s) listed below for:
Semester: Year:

Accommodation Codes
1. Accessible classrooms/facilities	2. Electronic texts (CD or tape)
3. Enlarged print materials	4. Tape recorder in class
5. Interpreters	6. Note taker
7. Reader for tests	8. Scribe for tests
9. Quiet separate test location	10. Extended time on tests
11. Alternative seating (specify):
12. Adaptive technology (specify):
13. Other (specify):

Course (i.e. ANT 100)	Professor	Location	Accommodation Codes
First Course	First Professor	First Course Location	Accommodation Codes for First Course
Second Course	Second Professor	Second Course Location	Accommodation Codes for Second Course
Third Course	Third Professor	Third Course Location	Accommodation Codes for Third Course
Fourth Course	Fourth Professor	Fourth Course Location	Accommodation Codes for Fourth Course
Fifth Course	Fifth Professor	Fifth Course Location	Accommodation Codes for Fifth Course
Sixth Course	Sixth Professor	Sixth Course Location	Accommodation Codes for Sixth Course

Please check one:
	I give permission to release any information related to my disability to program staff, Administrative Services, my instructor(s) and their respective division/program chairs that might help in the understanding of my special needs and provision of services.
	I give permission to disclose only that I have a documented disability, but not the nature of that disability, to program staff, Administrative Services, my instructor(s) and their respective division/program chairs.

By submitting this form, I state that all information provided is factual, and all accommodations requested are for legitimate reasons. Submission of this form indicates that I agree to and understand the conditions necessary to receive disability accommodations, and required documentation of my disability have been/will be provided as necessary.