SAIC Forms Accommodation Request Form

If you are a student currently registered with the DLRC and have received accommodation letters for a prior semester and you are not requesting any changes, please complete the form below to request letters for the present semester.

Please note: this on-line submission form is not being sent via a secure server. If utmost confidentiality is a concern for you, please download the PDF version of the Accommodation Request Form which can be submitted in person, by mail, or by fax.

Please make sure you have completed all fields before submitting. You should see an acknowledgment of your submission. If you do not see an acknowledgment, contact the DLRC at: 312.499.4278 or TTY 312.499.4287, or email: dlrc@saic.edu.

* denotes required information

Semester*

Year*

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Hidden

Cell Phone*

Preferred Email Address*

I acknowledge that I am responsible for the printing and delivery of my accommodation letters. I also acknowledge that by requesting academic accommodations, I am authorizing DLRC staff to discuss information relevant to the recommended accommodations with faculty and staff who have a need to know. I understand that, as with all SAIC activities, I am required to comply with the SAIC Student Code of Conduct, including the responsibility to accurately represent my circumstances.

A mark in this box signifies my acceptance of the above statement.*

After the form is submitted, your request will be processed and you will receive notification via email of the status of your request. Important note: you are responsible for printing copies of the letter to deliver to your instructors.

Phone

This field is for validation purposes and should be left unchanged.