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  • Please fill out the next page to let us know how we can help you.
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  • I am requesting the following accommodations . . . .
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  • Please send me information about . . . .
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  • Use these definitions to help ensure that you receive the information you need.

    Head Injury/Traumatic Brain Injury: i.e. temporary or permanent neurocognitive symptoms of a concussion, illness, traumatic event or other head injury, also siezure disorder

    Learning Disability: i.e. dyslexia, auditory or visual processing disorder, math learning disorder, autism spectrum disorder, etc.

    Physical Disability: i.e. temporary or permanent mobility impairment, visual impairment, autoimmune or other chronic illness, etc.

    Psychological Disability: i.e. anxiety disorder, depression, bipolar disorder, schizoaffective disorder, post-traumatic stress, etc.

    Unsure/Other: i.e. working diagnosis, not previously evaluated or diagnosed, etc. - Please provide detailed questions in the text box above so that we can answer as fully as possible.