Request for Accommodation Form

Request for Accommodation Form

Complete this form for any food allergies, dietary restrictions, translation, interpretation, educational accommodations (IEP, 504), ADA, disabilities, and other special needs.
The National FFA Organization is committed to providing equal access to our events and activities for all people. Use this form to request accommodation or assistance at least 30 days before your event. All information submitted in this form will be kept confidential. Our staff will review the request upon receipt and contact the requestor with additional information.

The organization cannot guarantee accommodations or assistance if a form is received less than 30 days before an event.
Are you completing this request for:*
Participants Information:
Reason for completing this form; Please select all that apply*

ADA Accommodation RequestAllergy NotificationSpecial Dietary RequestSpecial Request/Accommodation that impacts participation in the program/event selected in this form.Request for Translation (written and/or oral) for conferences, awards, CDE/LDE'sRequest for Interpretation (written and/or oral) for conferences, awards, CDE/LDE'sOther
Please list allergy*
Please explain the type of exposure that causes the reaction (ingested, contact, inhaled, environmental)*
Today's Date*

MonthDayYear
Date
Participant's Name*

Participant First NameParticipant Last Name
Participant's Email*
example@example.com
Participant's Phone Number*

Area CodePhone Number
Parent/Guardian’s Name, if participant is under 21 years of age:

P/G First NameP/G Last Name
Parent/Guardian’s Email
example@example.com
Parent/Guardian’s Phone Number

Area CodePhone Number
State*
FFA Chapter Name*
FFA Chapter ID*
Advisor’s Name*

Advisor First NameAdvisor Last Name
Advisor’s Phone Number*

Area CodePhone Number
Advisor’s Email*
example@example.com
National FFA Program or Event: Select all that apply*

Agriscience FairAmerican Star FinalistCareer/Leadership Development EventsILSSONational Chapter Award FinalistNational FFA BandNational FFA ChorusNational FFA Convention (only no other options apply)National FFA DelegateNational FFA TalentNational Officer CandidateNext Gen ConferenceNew Century Farmer (NCF)Proficiency Award FinalistState Officer SummitWashington Leadership Conference (WLC)Other
Please select the specific event*
Questions to Clarify Accommodation(s) and/ or Assistance Requested
Please describe the accommodations you are requesting. If request is allergy related, share to what type of exposure is the reaction related (ingested, contact, inhaled, etc.) .*
If you have received accommodations for a previous FFA events, please list the accommodation you have received.*
Documentation of Disability:
Please provide documentation of the specific diagnosis and limiting nature of the disability by a board certified medical doctor, psychologist, or psychiatrist. Attach a PDF version of this documentation to your reasonable request for accommodations form.
Attach a PDF version of your specific diagnosis and limiting nature of the disability documentation provided by a board certified medical doctor, psychologist, or psychiatrist. You may attach any additional information that would be helpful to meet the requested accommodation.

Browse Files

Cancelof
Form Submission
Name of the Individual Submitting Request*

First NameLast Name
Relationship to the Participant:*
Email*
example@example.com
In Office Use
Documentation of Action Taken
Should be Empty: