VSA Educational Accommodation Request Form

Dear Families,

If your child has a learning disability or other documented medical need that impacts his or her education, we would like to be as supportive as possible and provide you with reasonable accommodations. If your student has particular needs, please complete the enclosed form so that we might consider how to best support you.

If indeed it is determined that special accommodations are warranted, a fee of $50 per course will be assessed in an effort to recuperate a portion of the costs VSA administration incurs in the process. The minimum charge for any accommodations is $150 per student.

Thank you, and as always, please reach out to edaccommodations@veritaspress.com with any questions.

Student Last Name

Student First Name

Parent Last Name

Parent First Name

Parent Email Address

Parent Phone Number

Area CodePhone Number

Is the student enrolled in the VSA Diploma Program?

YesNoNo, but please contact me with more information.

Who is the student's Academic Advisor?

Academic Year for educational accommodations

In what grade will your student be during the academic year for which you are requesting educational accommodations?

Please describe your child's disability and its impact on his/her education and daily life.

Please describe the educational accommodations being requested.

Use this link to upload medical documentation. Documentation is required for accommodation consideration.

By submitting this form, I certify that the information provided on this form is accurate. I understand that to be considered for academic accommodations at Veritas Scholars Academy I must (1) submit this completed form, and (2) submit updated disability documentation (if there are any changes) that substantiates the requested accommodations. Accommodations are assessed each academic year and prior approval does not guarantee approval for all subsequent years. Please allow ten days for a response.

What are the last four digits of the credit card you would like charged for accommodations?

VSA Educational Accommodation Request Form - Initial