Letter of Accommodations Request Form Directions Prior to submitting your Letter of Accommodation Request Form below, please consider carefully which of your approved accommodations are relevant to your needs for each course you are enrolled this semester. For example, if your grade in a course is based on papers and a class presentation, then there is no need to request extended time (50%) accommodation for that course. Please refer to your course syllabus to determine which accommodations you wish to use in an individual course. If you have any concerns or questions please contact your ODS coordinator. Please complete only one form per course. Visit our Letter of Accommodation page for more information on the LOA process. Please note: Rutgers Law School students do not use this form. The university seeks to promote the comfort and safety of students who wish to be identified by a name other than their legal name by instituting a preferred name procedure. Please visit the Registrar’s Name Change Procedure and follow the steps indicated. If you wish to have your preferred name on your Letter of Accommodation, please fill it out in the form below and include your preferred name. New Information Regarding Instructors By submitting the Letter of Accommodation (LOA) request form, a Letter of Accommodation will be sent to both you and to your faculty member. RBHS Medical and Dental students please note: RBHS Medical Students: Letter of Accommodation will go to both you and the Student Affairs Office. RBHS Dental Students: Letter of Accommodation will go to both you and the Academic Affairs Office. Student Information RUID or A-Number * Legal First Name * Preferred First Name Last Name * Primary Email Address * Secondary Email Address Course/Activity and Accommodation Information Campus * [Select Campus] New Brunswick/Piscataway Newark Camden RBHS Atlantic Cape Community College Brookdale Community College Camden County Community College Community College of Morris Joint Base McGuire Dix-Lakehurst Mercer Campus Community College Princeton Raritan Valley Community College Rowan College at Burlington County School * [Select School] Robert Wood Johnson Medical School New Jersey Medical School Rutgers School of Dental Medicine Schl of Health Related Professions (Ug) Schl of Health Related Professions (G) School of Public Health School of Graduate Studies - Rbhs School of Nursing - New Brunswick (Ug) School of Nursing - New Brunswick (Grad) Biopharma (G) RBHS Campus [Select RBHS Campus] Blackwood Camden Distance Education Hybrid Health Sciences - Newark New Brunswick Offsite-Clinical Piscataway Scotch Plains Ramapo Stratford Web-Based Course Is this Letter of Accommodation for a Rutgers based course, RBHS Medical/Dental Full Academic Year, or Neither? * Yes, Rutgers based Course RBHS Medical/Dental Full Academic Year Neither a Rutgers based course or RBHS Year Semester * Full Academic Year 2024-2025 (Medical/Dental Students Only) Fall 2024 Winter 2025 Course Name * (e.g. Calculus 1) Course Subject and Number * (e.g. 640:135, or REHB:9000K for RBHS) Course Index Number / Course Reference Number (CRN) * (e.g. 01234) If you need to search for your instructor's contact information, please use the Rutgers People Search: https://search.rutgers.edu/people. Primary Instructor Full Name * Primary Instructor Email Address * Secondary Instructor Full Name Secondary Instructor Email Address Additional Non-Instructor Contact Email We could not find a record of this email address for your instructor(s), please verify the following: I have searched my instructor's detailed contact information on Google or Rutgers people search * Yes No I confirm what I entered is correct * Yes No Please note that the below request is ONLY for non-Rutgers based courses or other activities. If you need this letter for a Rutgers based course please select “Yes” above Why are you requesting this letter? * Accommodations: 100% extra time on OSCE written note 50% extra time on OSCE written note Access to medical equipment during labs, class and exams Access to snacks/food/drinks during labs, class and exams Alternate Format for Textbooks or Course Materials American Sign Language Interpreter / CART Services Breaks during timed exams/quizzes Consideration with regard to absences & missed exams / quizzes Enlarged Print (font size) Exams to end by 8:00pm Extended time (100%) for in class/online timed exams and quizzes Extended time (50%) for in class/online timed exams and quizzes Extension on Assignments, up to 48 hours, within the academic standards of the course No Scantrons for exams/quizzes Notetaking - in person or recording device Notetaking - recording device ONLY Permission to use a laptop / tablet for notetaking Preferred Seating Reduced distraction testing location Reduced distraction testing location - with proctor only Service Animal Use of a calculator on exams/ quizzes - unless it compromises an essential function of the course Use of a computer for essay exams / quizzes ONLY Use of a computer for exams / quizzes Use of a lab / classroom assistant Use of a podium during testing Use of a reader for exams /quizzes Use of a screen / text reader for exams/quizzes Use of a screen / text reader for textbooks/course materials Use of a scribe for exams/quizzes Use of FM system in class Other approved accommodations required this semester, not listed above: Submit