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)