Request for Accommodations
Email address
Hope College follows FERPA law to protect the privacy of each student. In the course of work with each student, however, it is sometimes helpful to discuss situations with a professor, administrator, rehabilitation counselor, medical specialist, or other professional. By submitting this form, I give permission for Disability Services to disclose information about me for the purposes of determining eligibility for services, determining and implementing appropriate accommodations, for safety and evacuation planning and coordinating services. I understand that my request for accommodations may not be addressed until all required documentation is received.
We will contact you with next steps once this form is received. New students will be asked to schedule an in person appointment. Returning students may be asked to schedule an appointment as needed.
First Name:
Your answer
Last Name:
Your answer
Middle Initial:
Your answer
Student ID#:
Your answer
Phone#:
Your answer
Date of Birth:
MM
/
DD
/
YYYY
Permanent Address:
(Not your campus address)
Your answer
City
Your answer
State:
Your answer
Zip:
Your answer
Are you a
Expected year of Hope graduation:
Your answer
Declared (or interest) major or degree program:
Your answer
Academic Advisor (FYS professor for freshman):
Your answer
Are you working with Michigan Rehabilitation Services?
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