ADHD School Accommodation Request Form
Request school accommodations for students with ADHD. Please complete all sections to help us understand and support your needs.
Student Full Name
*
First Name
Last Name
Parent or Guardian Name
*
First Name
Last Name
Student Grade Level
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
School Name
*
Student Email Address
example@example.com
Parent or Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Does the student have a formal ADHD diagnosis?
*
Yes
No
Prefer not to say
Current Accommodations in Place (if any)
Requested School Accommodations
*
How does ADHD impact the student's learning or school experience?
*
Additional Comments or Information
Submit Request
Should be Empty: