It is the student's responsibility to accurately complete this form. Refer to your class schedule. Student ID # Last Name First Name College Email Phone Number Type of Service - Select -Adaptive FurniturePreferential Seating Type of Adaptive Furniture Needed Location In Classroom Front Center Back Near Door Other location in classroom... Enter other… Reserved Sign Comments All requests will have reserved signs on the furniture with the days and time of your class (no name). If you want additional information added to the sign or have concerns, state it in the comments below. Schedule Requested One-Time Weekly Start Date End Date Ticket Number Course Name e.g. ECON 1, MATH 253 Instructor's Name (Optional) Class Days Monday Tuesday Wednesday Thursday Friday Saturday Start Time End Time Room Number Furniture & Seating Agreement I agree. I understand that I must show my “Accommodation Form” to my instructor to verify this reservation. This request will be processed with 72 business hours. I will contact DSPS if I have any concerns immediately.