ACCESS Accommodation Request

Student must be registered for semester requesting accommodations

Student Name

Are you a current ACCESS student?

For which semester are you registered in and requesting accommodations?

Would you like ACCESS to reach out to you schedule you an ACCESS Counseling appointment, to make changes to your accommodations or for other reasons?

I verify that I am an ACCESS student at �� and understand this is a voluntary program. I am completing this form to request my accommodations for the semester registered in, no changes are necessary, and I understand that any changes to my Academic Accommodation Plan requires an appointment with the ACCESS Counselor

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ACCESS Accommodation Request

Main Campus

Fort Irwin Campus

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ACCESS Accommodation Request

Main Campus

Fort Irwin Campus

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