University Lecture Accessibility Service Request Form
Submit your request for accessibility accommodations in university lectures. Please provide complete and accurate information to help us process your request efficiently.
Full Name
*
First Name
Last Name
Student ID Number
*
University Email Address
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Course Code or Name
*
Lecture Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Type of Accessibility Support Requested
*
Sign language interpretation
Note-taking assistance
Lecture recording
Captioning services
Accessible seating
Other
Please describe your accessibility need or request in detail
*
Preferred Service Format
*
In-person
Online/Remote
Hybrid (In-person & Online)
Urgency of Request
*
Routine (more than 1 week before lecture)
Soon (within 1 week of lecture)
Urgent (less than 48 hours before lecture)
Upload supporting documentation (optional)
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