Accommodation Request Form
First Name: *
Last Name: *
Phone *(Choose at least one)
Email Address *
Number of Classes you are taking *
Please select which semester this request is for *
Please choose one of the options below *
I am returning to Wayne College and have no changes to my accommodations.
I am returning to Wayne College but have changes to my accommodations. Please contact me to set up an appointment.
I am requesting accomodations for the first time at Wayne College. Please contact me for an appointment.
An asterisk (*) denotes a required field
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