REQUEST FOR SPECIAL ACCOMMODATIONS

Personal Information
Academic Information
Disability Information
Accommodation History
Certification

I certify that the information provided on this form is accurate. I understand that to be eligible for special accommodations at ULM, I must 1) submit this completed form, 2) submit disability documentation that substantiates the requested accommodations, and 3) participate in an intake interview with the Special Accommodations Coordinator.My signature authorizes the Self-Development,Counseling and Special Accommodations Center to discuss my documentation with the clinician who authored the documentation if additional information or clarification is required.

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