ODR Accommodation Request Form | Bryn Athyn College

Personal Identification and Contact Information:

Date: *

Term: *

First Name *

Last Name *

Date of Birth *

Email Address: (Please list BAC email if you are a current student) *

Address at which you would like to receive correspondence from The Office of Disability Resources:

Address 1 *

Address 2

City *

Zip Code *

Country

What is your enrollment status? *

Prospective Student
Undergraduate Student
Other

If you selected other, please specify:

What is your Major or Program of Study?

If you selected other, please specify:

Is this condition:

temporary
permanent

If temporary, please indicate the expected time required for recovery:

If you selected other, please specify:

Is this the first time you are requesting accommodations through Office of Disability Resources?

yes
no

Please detail any new accommodation requests you may have and/or any new condition you may be presenting at this time. New students- please list the accommodations you are requesting:

If you have previously received an Accommodation Verification Letter (AVL), are you now requesting the same accommodations for the new term?

yes
no

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