The Catholic University of America

ACCOMMODATION REQUEST FORM

Students are strongly encouraged to make requests for accommodations at the end of the previous semester for the following semester and to submit this form as soon as possible.

After you register for the current or upcoming semester, submit this form to DSS.  Make sure you enter the semester, your name and student ID number correctly so that the system will attach the right schedule automatically.

Your accommodations will remain the same as the previous semester.  If you would like to make an adjustment, you must meet with a DSS staff person to discuss the accommodation change. Students will be notified by email when their letters are complete.  Students must allow at least 72 hours for processing during peak times. Students must then pick up the letters to personally deliver to their professor(s).

To ensure that letters are correct, please fill out the information completely.

Today's Date (mm-dd-yy): 
Semester Requesting Accommodations for: Fall Spring Summer       Year:
Name: Student ID:
Campus/Current Address (Line 1):
Campus/Current Address (Line 2):
Campus/Current Address (Line 3):
CUA Email: Phone Number:
School/Program: Major:
Academic Classification: Freshman Sophomore Junior Senior Graduate Law
For returning students only:
Do you plan to use e-text for any of your classes this semester? Yes No
Do you need classes to be moved due to your physical limitations?
(Please note which classes on your attached schedule)		 Yes No
Do you need library access this semester (for physical disabilities)?
 Yes No
Are you graduating this semester? Yes No
Are you requesting the same accommodations as last semester? Yes No
Are you interested in discussing changing your accommodations? Yes No
Student Signature:
(Signature required at the time letters are picked up.)

Date (mm-dd-yy):

Staff Initials: