Supplemental Forms

Accommodation Request Form for Deaf and Hard of Hearing Students

If you have been determined eligible for SDC services, please complete the form below with as much detail as possible. After the form has been submitted, your request will be processed and you will be contacted when your accommodations have been approved. You will then need to come in to the Student Disability Center to sign the paper copy of the request and pick up any supporting documentation related to your accommodations.

On-line submissions are not secure. It is extremely unlikely this form would be intercepted, but if utmost confidentiality is a concern, please use the PDF which can be submitted in person, by mail, or by fax. See the Contact Us page for address and phone numbers.

Important! You should see an acknowledgment of your submission. Examine it carefully for errors. If you find any, or do not see an acknowledgment, contact the SDC at:
(530) 752-3184 (voice).

Some of the files on this site are provided in portable document format (pdf). A program that can read and/or print pdf files, like Adobe Acrobat Reader, may be required.

Accommodations requested for:


I acknowledge that by requesting academic accommodations, I am authorizing the SDC Disability Specialist to discuss information relevant to the recommended accommodations with faculty and staff who have a need to know. I understand that, as with all University activities, I am required to comply with the UC Davis Student Code of Conduct, including the responsibility to accurately represent my circumstances.

 

Specify Interpreters, Captioners, Assistive Listening Devices (ALDS), Notetakers (Stipend, Communication Assistant, or Transcript) and/or other requests for each section as needed.

If you request exam accommodations you must provide exam formats such as multiple-choice, problem-solving, essay, short answer, fill-in. Please check with professors.

 


1.
 
 
  Accommodation(s) Requested Days Times Location
Lecture
Discussion
Lab
Exam Format

 

2.
 
 
  Accommodation(s) Requested Days Times Location
Lecture
Discussion
Lab
Exam Format

 

3.
 
 
  Accommodation(s) Requested Days Times Location
Lecture
Discussion
Lab
Exam Format

 

4.
 
 
  Accommodation(s) Requested Days Times Location
Lecture
Discussion
Lab
Exam Format

 

5.
 
 
  Accommodation(s) Requested Days Times Location
Lecture
Discussion
Lab
Exam Format

 

6.
 
 
  Accommodation(s) Requested Days Times Location
Lecture
Discussion
Lab
Exam Format