Student Request For Course Accessibility Letter
Banner ID#
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Full Name
*
First Name
Last Name
Preferred Name
NMT Email
*
example@student.nmt.edu
Contact #
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Please enter a valid phone number.
Semester
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Fall
Spring
Summer
Intersession
Year
*
I am requesting Course Accessibility Letters for the following:
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Department (example: MATH)
Course No./Section (example: 101-01)
Instructor/Prof/TA
State / Province
Postal / Zip Code
I am requesting Course Accessibility Letters for the following:
Department (example: MATH)
Course No./Section (example: 101-01)
Instructor/Prof/TA
State / Province
Postal / Zip Code
I am requesting Course Accessibility Letters for the following:
Department (example: MATH)
Course No./Section (example: 101-01)
Instructor/Prof/TA
State / Province
Postal / Zip Code
I am requesting Course Accessibility Letters for the following:
Department (example: MATH)
Course No./Section (example: 101-01)
Instructor/Prof/TA
State / Province
Postal / Zip Code
I am requesting Course Accessibility Letters for the following:
Department (example: MATH)
Course No./Section (example: 101-01)
Instructor/Prof/TA
State / Province
Postal / Zip Code
I am requesting Course Accessibility Letters for the following:
Department (example: MATH)
Course No./Section (example: 101-01)
Instructor/Prof/TA
State / Province
Postal / Zip Code
I am requesting Course Accessibility Letters for the following:
Department (example: MATH)
Course No./Section (example: 101-01)
Instructor/Prof/TA
State / Province
Postal / Zip Code
I am requesting Course Accessibility Letters for the following:
Department (example: MATH)
Course No./Section (example: 101-01)
Instructor/Prof/TA
State / Province
Postal / Zip Code
I am requesting Course Accessibility Letters for the following:
Department (example: MATH)
Course No./Section (example: 101-01)
Instructor/Prof/TA
State / Province
Postal / Zip Code
Academic Advisor
*
Today's Date
*
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Month
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Day
Year
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I, the undersigned, authorize the staff providing disability accommodation services to contact relevant New Mexico Tech student services staff, faculty or administration to share information pertaining to my accommodation(s) for the purpose of coordinating appropriate services and determining any necessary and reasonable academic accommodations.
*
Type name above to count as electronic signature.
The Institution will provide accommodations to students with disabilities to enable students to meet institutional standards without compromising the Academic Integrity of the course, program, assignment or activity.
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