Los Angeles Pacific University partners with the Learning Enrichment Center (LEC) at Azusa Pacific University to coordinate accommodations for undergraduate and graduate students with specific disabilities. Accommodations are individualized based on the learning needs of each student and upon documented verification of disability. Please visit our website (www.lapu.edu/resources/accessibility/) for more information.

All department chairs, program directors, success coaches, and e-learning team members will be provided the accommodation memo in addition to faculty.

IMPORTANT NOTE: Academic accommodations must be requested prior to each session by filling out this form.

Today's Date *
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LAPU Student ID Number *
Your answer
Current Term *
Semester and Session
Name (first and last) *
Your answer
Registered Courses
Please provide a list of all the courses you are registered for at Los Angeles Pacific University
Course #1 - Course Number and Name *
Example: "MO101- Momentum
Your answer
Course #2 - Course Number and Name
Your answer
Course #3 - Course Number and Name
Your answer
Course #4 - Course Number
Your answer
Do you authorize LAPU to share your accommodations, once approved, with the identified instructors? *
Required
Do you authorize LAPU to share your accommodations, once approved, with LAPU student support staff? *
Required
If instructors are not yet identified, do you authorize LAPU to share your accommodations, once approved, with the instructors selected to teach each course? *
Required
Student's Electronic Signature
The completion and return of this form will serve as the student's signature indicating permission for Los Angeles Pacific University to send their Accommodation Memo via email to identified faculty and student support staff.
Date *
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YYYY
Time
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