ADA Accommodations Request Form

ADA Accommodations Request Form
Please provide the following information requested:
Name of the University of Holy Cross student seeking disability accommodations:

First NameLast Name
UHC Email
example@example.com
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
If approved by the University of Holy Cross for accommodations, submit the name of all professor(s) that you wish to send any approved accommodations to for the upcoming/current semester.
Name of Professor

First NameLast Name
Name of Professor

First NameLast Name
Name of Professor

First NameLast Name
Name of Professor

First NameLast Name
Name of Professor

First NameLast Name
Name of Professor

First NameLast Name
Please upload a letter from a medical professional documenting your accommodations request.

Cancelof
Thank you for providing this information.
Your application will be reviewed in a timely manner. You will be contacted through your UHC email regarding the determination made reguarding this ADA request.
Should be Empty:

Please provide the following information requested: