1. Student Waiver of Services/Accommodations Form


Student Waiver of Services/Accommodations Form

 

Please complete the Student Waiver of Services/Accommodations form when the student chooses not to use the services and/or accommodations. Both student and instructor must complete this form for every class and test when necessary.

Student’s name:________________________________________________________________________

Instructor’s name: _____________________________________________________________________

Course:______________________________________________________________________________

Services/Accommodations:______________________________________________________________

Date:________________________

Reason for Services Waiver:______________________________________________________________

 

 

___________________________          _________________________

Student’s signature               Instructor’s signature

 

 

 

Note: Student must submit this original form to Disability Services Coordinator at Delgado Community College.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form 1468/003 (1/11)

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