Request for Accommodations
(This form will be sent to your Disability Access Consultant)

Today's Date: 
ASU Student ID#:(ex. 123-45-6789)
Last Name: First Name:
Student Phone#: 

Student E-mail (required):

VR Sponsored?  
VR Counselor:  
VR Phone#: Disability Access Consultant:
Semester:    Year:

  Service Codes:   I=Interpreting     CART=Computer-Aided Real Time    
Drop/Add Service Schedule Line # Course Prefix Course title Credits Days Time Location Campus Instructor

**Before sending this request PLEASE READ**

Notification/Cancellation of Services Policy

> If you plan to miss a class, you must notify the Interpreter Supervisor.

> Notifying the Interpreter Supervisor that you will miss class less than 48 hours in advance but more than 60 minutes before the class, is considered a Late Notice. Failure to contact the Interpreter Supervisor less than 60 minutes prior to class is considered a No Show. Two Late Notices is considered as one No Show. If you receive three No Shows in any one class, your service accommodations for that class can be suspended until you meet with your Disability Access Consultant.

> Service providers will wait 5 minutes for every half hour of class time (max. of 15 min) to verify attendance before leaving. At that time, the student will be given a No Show.


I have read and understand the Notification/Cancellation of Services Policy.  (Please check)

If you have additional questions regarding services, please see your Disability Access Consultant.