ࡱ> ;=:q` ^%bjbjqPqP .&::^l l l l ,  l 8'))))))$fhMEM " M M M 7w w w M   'w M 'w w w l l W w 0w Vm Vw Vw M M w M M M M M MMm M M M M M M M l l  Sample Accommodation Letter  *Confidential* REQUEST FOR ACADEMIC ACCOMMODATIONS TO: (Instructors Name) FROM: (Name), Coordinator, Disability Services for Students DATE: (Insert Date) RE: Accommodation(s) for: (Student Name) Students ID Number: XXXXXXXX  FILLIN XXX-XX-XXXX \* MERGEFORMAT  Course & Section: ENGL1010-000 FILLIN ENGL-1010-001 \* MERGEFORMAT  The above-named student is enrolled in your course. The Disability Services for Students (DSS) office has thoroughly reviewed this student s documentation and is recommending the following accommodations as necessary to maximize the student s participation and success in your class. TESTING ACCOMMODATIONS CLASSROOM ACCOMMODATIONS  FORMCHECKBOX  Extended Time ( FORMTEXT      )  FORMCHECKBOX  Taped Lecture  FORMCHECKBOX  Separate Location  FORMCHECKBOX  Peer Note-taker*  FORMCHECKBOX  Oral testing  FORMCHECKBOX  Extended time for in-class assignments  FORMCHECKBOX  Assistive Technology (computer)  FORMCHECKBOX  Assistive Listening Equipment  FORMCHECKBOX  Scribe/Reader  FORMCHECKBOX  Sign Language Interpreter  FORMCHECKBOX  Other:  FORMTEXT       The implementation of academic accommodations is a shared responsibility between the student, the professor and DSS. Please discuss each requested accommodation and how it will be implemented so that it is appropriate to both the students needs and the format of your course. If you have any questions or would like assistance with this process, please feel free to contact me at (phone number) or email me at  HYPERLINK "mailto:amcmahon@ccri.edu" (email username)@ccri.edu. Thank you for assisting us in providing equal access and opportunity for all students. -QS / 0 1 3 D E R S z { 6 չwhSCSh7h7hSCShhCJOJQJaJ *hhR%hCJOJQJaJ(j *hhR%hCJOJQJUaJhhR%hCJOJQJaJhhR%hOJQJhhR%h5;OJQJ&hhR%h5;CJOJQJ^JaJ)hhR%hB*CJOJQJ^JaJph7jhB*CJOJQJU^JaJmHnHphu)hhB*CJOJQJ^JaJph)hhR%hB*CJ,OJQJ^JaJ,ph-QRSlm1 | } 4 6 R $^`a$gdgd$a$gd $^a$gd$a$gd $^a$gd dd[$\$gd^%6 b h     , . 0 R T p r lV@+j`hhR%hCJOJQJUaJ+jhhR%hCJOJQJUaJ;jhhR%h>*CJOJPJQJU^JaJmHnHu.jthhR%h>*CJOJQJUaJ(jhhR%h>*CJOJQJUaJ+jhhR%hCJOJQJUaJ%jhhR%hCJOJQJUaJhhR%hCJOJQJaJhhR%h>*CJOJQJaJr t   8 : V X Z 68:|~ݱݛ݅oY+jhhR%hCJOJQJUaJ+jhhR%hCJOJQJUaJ+j0hhR%hCJOJQJUaJ+jhhR%hCJOJQJUaJ+jHhhR%hCJOJQJUaJ+jhhR%hCJOJQJUaJhhR%hCJOJQJaJ%jhhR%hCJOJQJUaJ" |"$O$P$t$u$$$$$%%%]%^%$a$gdgd$a$gd$&BDF\^rtv `aDZǜtVFFhhR%h6CJOJQJaJ;jhhR%h>*CJOJPJQJU^JaJmHnHu.jxhhR%h>*CJOJQJUaJhhR%h>*CJOJQJaJ(jhhR%h>*CJOJQJUaJ+jhhR%hCJOJQJUaJhhR%hCJOJQJaJ%jhhR%hCJOJQJUaJ+jhhR%hCJOJQJUaJ$d$k$o$u$$$$$]%^%ֶh5 hhR%h5CJOJQJaJhhR%h>*CJOJQJaJUhhR%hCJOJQJaJ hhR%h0JCJOJQJaJ%jhhR%hCJOJQJUaJ+jhhR%hCJOJQJUaJSignature of DSS Coordinator: ______________________ Date____________________ Signature of Student Date Signature of Faculty Member Date Please sign and return the original copy of this letter to the Disability Services for Students office on your campus. 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