Accommodation Request Form
This form is for approved DRC students only
I am requesting accommodations for:
My DRC Counselor is:
Contact Information
First Name: (required field)
Last Name: (required field)
L-Number: (required field)
(ie: 000123456, do not type in the "L")
Rebel Email: (required field)
Phone: (required field)
Best way to reach you?

Instructions:
  • Identify the accommodations that you are requesting for each course below.
  • Do not request accommodations for which you are not eligible.
  • When finished entering accommodations for each class scroll to the bottom of this form to submit your request.
Course 1:
Class Name:
(required field)
(ie. HIS 320 . 001)
Class Title:
(required field)
(ie. American History)
Instructor Name: (required field)
Testing accommodations
for this class: 		Yes No
  Describe testing accommodations
you are requesting:
 
   
Notetaking service
for this class: 		Yes No
   
Locating notetakers: I prefer to locate a notetaker myself I prefer instructor assistance with locating a notetaker
   
Notes Delivery: Pick-up at DRC Direct Exchange Online Notes
   
Accessible Furniture
for this class: 		Table Chair Table and Chair

Building/Room: (ie. WRI C212 )
   
Communication
Access Services: 		Interpreter CART Typewell
   
Describe Other Accommodation
Requests:

Note: If you have entered all of your classes scroll to the bottom of this form and press the submit button, otherwise continue entering additional courses below.

Course 2:
Class Name:

(ie. HIS 320 . 001)
Class Title:

(ie. American History)
Instructor Name:
Testing accommodations
for this class: 		Yes No
  Describe testing accommodations
you are requesting:
 
   
Notetaking service
for this class: 		Yes No
   
Locating notetakers: I prefer to locate a notetaker myself I prefer instructor assistance with locating a notetaker
   
Notes Delivery: Pick-up at DRC Direct Exchange Online Notes
   
Accessible Furniture
for this class: 		Table Chair Table and Chair

Building/Room: (ie. WRI C212 )
   
Communication
Access Services: 		Interpreter CART Typewell
   
Describe Other Accommodation
Requests:

Note: If you have entered all of your classes scroll to the bottom of this form and press the submit button, otherwise continue entering additional courses below.

 

Course 3:
Class Name:

(ie. HIS 320 . 001)
Class Title:

(ie. American History)
Instructor Name:
Testing accommodations
for this class: 		Yes No
  Describe testing accommodations
you are requesting:
 
   
Notetaking service
for this class: 		Yes No
   
Locating notetakers: I prefer to locate a notetaker myself I prefer instructor assistance with locating a notetaker
   
Notes Delivery: Pick-up at DRC Direct Exchange Online Notes
   
Accessible Furniture
for this class: 		Table Chair Table and Chair

Building/Room: (ie. WRI C212 )
   
Communication
Access Services: 		Interpreter CART Typewell
   
Describe Other Accommodation
Requests:

Note: If you have entered all of your classes scroll to the bottom of this form and press the submit button, otherwise continue entering additional courses below.

Course 4:
Class Name:

(ie. HIS 320 . 001)
Class Title:

(ie. American History)
Instructor Name:
Testing accommodations
for this class: 		Yes No
  Describe testing accommodations
you are requesting:
 
   
Notetaking service
for this class: 		Yes No
   
Locating notetakers: I prefer to locate a notetaker myself I prefer instructor assistance with locating a notetaker
   
Notes Delivery: Pick-up at DRC Direct Exchange Online Notes
   
Accessible Furniture
for this class: 		Table Chair Table and Chair

Building/Room: (ie. WRI C212 )
   
Communication
Access Services: 		Interpreter CART Typewell
   
Describe Other Accommodation
Requests:

Note: If you have entered all of your classes scroll to the bottom of this form and press the submit button, otherwise continue entering additional courses below.

Course 5:
Class Name:

(ie. HIS 320 . 001)
Class Title:

(ie. American History)
Instructor Name:
Testing accommodations
for this class: 		Yes No
  Describe testing accommodations
you are requesting:
 
   
Notetaking service
for this class: 		Yes No
   
Locating notetakers: I prefer to locate a notetaker myself I prefer instructor assistance with locating a notetaker
   
Notes Delivery: Pick-up at DRC Direct Exchange Online Notes
   
Accessible Furniture
for this class: 		Table Chair Table and Chair

Building/Room: (ie. WRI C212 )
   
Communication
Access Services: 		Interpreter CART Typewell
   
Describe Other Accommodation
Requests:

Note: If you have entered all of your classes scroll to the bottom of this form and press the submit button, otherwise continue entering additional courses below.

Submitting your Request:
  • I have identified all my classes and accommodation requests above .
  • If I add classes I will prepare another online request for the additional classes.
  • If I drop classes I will email the changes to DRC at DRC@unlv,edu .
  • I am requesting DRC prepare Academic Accommodation Plans "letters" for me.
  • I understand that accommodations are not in place until I meet with and present the "letters" to my instructors.

By submitting this form I agree to the above items.

If you would like a copy of this request please print before pressing the submit button below .