Accommodation RequestFill out some info and we will be in touch shortly! Student Information * First Name Last Name Date of Birth * MM DD YYYY Email * Phone (###) ### #### Type of Accommodation Requested * Previous Accommodations * Have you ever received accommodations before? If so, please specify. By checking this box and submitting this form, I attest that the information provided is accurate to the best of my knowledge. * Yes I consent to allow Academy of America and its representatives to release and verify medical or professional information as needed. Yes No Digital Signature Date MM DD YYYY Thank you!
