Accommodation Notice Form

By completing this form, you are requesting accommodation notices for your approved academic accommodations be sent for the classes listed below. An Accommodation Notice request form must be completed each semester if you are requesting academic accommodations. Please note, not all accommodations may be applicable for all
courses due to course modality and student learning outcomes.

Name Name * First Last
A# (ex. A00000000) *
Date of Birth Date of Birth * / MM / DD YYYY
Student SUNY Orange Email *
Phone Phone * - ### - ### ####
Campus *
What APPROVED accommodations are you requesting? Please note, not all accommodations may be applicable for all courses due to course modality and student learning outcomes. If you are requesting any additional accommodations, please contact OAS.

Requested accommodations should be the accommodations discussed and approved by OAS during the student intake appointment.
Current Semester - archive 1

Please complete a separate renewal request for each semester.
Current Semester - archive 2

Please complete a separate renewal request for each semester.
Current Semester - archive 3

Please complete a separate renewal request for each semester.
Current Semester *

Please complete a separate request for each semester.
How many courses are you requesting accommodations for? *

You do not have to list courses that accommodations may not be applicable to. For example, some PE courses.
Enter the course abbreviation and corresponding section for all the classes for which you are requesting accommodations.
Course and Section #1 (ex. ENG101 QC)
Course and Section #2 (ex. ENG101 QC)
Course and Section #3 (ex. ENG101 QC)
Course and Section #4 (ex. ENG101 QC)
Course and Section #1 (ex. ENG101 QC)
Course and Section #6 (ex. ENG101 QC)
Course and Section #1 (ex. ENG101 QC)
Student Acknowledgement *

Student Acknowledgement By submitting this form, I acknowledge and understand the following: I am authorizing OAS to e-mail my faculty an accommodation letter listing my approved accommodations for this semester. My request for academic accommodations are not approved until I receive a notice of approval via my SUNY Orange email. Accommodations are not retroactive. If there are any questions regarding my request, I will receive an email to make an appointment with Accessibility Services. I understand my request may take up to 10 days. If I do not recieve my accommodation letter within 10 days, I will contact OAS.

Accommodation Notice Form

Accommodation Notice Form

Enter the course abbreviation and corresponding section for all the classes for which you are requesting accommodations.