Semester Accommodation Request Form

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Fields marked with * are required.

Please indicate every semester you will need services for the school year.
Semester Accommodations being requested:*


numbers only, no spaces, and include area code

numbers only, no spaces, and include area code

In case of Emergency, who may we contact?

numbers only, no spaces, and include area code

Did you receive accommodations last semester?*

Are you planning to return next semester?*

National Voter Registration Act: If you require assistances re-certifying, renewing, or changing your address please check one:*

If you are not registered to vote where you live now, would you like to apply to register to vote here today?*

Applying to register or declining to register to vote will not affect the amount of assistance that you will be provided by this agency.
Voter eligibility requirements are found on the voter registration application form.

Note: If you do register to vote, the location where your application was submitted will remain confidential.
If you decline to register to vote, this fact will remain confidential.
Applying to register or declining to register to vote will be used only for voter registration purposes.

If you would like help in filling out the voter registration application form, we will help you. The decision whether to seek or accept help is yours. You may fill out the application in private.*

For assistance in completing the voter registration application form outside our office,
contact Student Services at (337) 421-6947 or

If completed outside our office, this declaration form and your completed voter registration application form
(if you filled one out) should be returned to SOWELA, 3850 Sen. J Bennett Johnston Ave., Magnolia Building- Student Success Center, Lake Charles, LA 70615.

Student Agreement

  • I understand the responsibility for obtaining reasonable accommodations in the classroom is mine.
  • I understand if I am requesting new accommodations, I must meet with my DS Counselor prior to having these accommodations approved.
  • I understand that if I am testing in the Disability Services, a completed testing form signed by myself and my instructor must be submitted to the Disability Services three (3) days prior to each exam. I also understand that during finals, I am encouraged to have the testing request forms submitted at least one (1) week in advance.
  • I understand that I am responsible for following the Disability Services policies and procedures outlined in the Disability Services Student Handbook and that failure to comply with these policies and procedures may result in my not receiving accommodations.
  • I understand that if I request note taking services through Disability Services, my e-mail address will be posted in the Note Taker Packet. (If this is a problem, please speak with your DS Counselor.)
  • I understand that my SEMESTER ACCOMMODATION LETTERS will be sent to my instructors, unless a written letter has been given to the office stating otherwise.
  • I understand it is my responsibility to discussed my semester accommodation letter with my instructor at the beginning of the semester. (ACCOMMODATIONS ARE NOT RETROACTIVE.)
  • I understand that my semester accommodation letters will ONLY be sent to my school email address.

I agree to and understand the conditions stated above.

Enter first and last name