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Request for Academic Accommodations
Please fill out the the following information:
First Name
Middle
Last Name
The academic accommodations that I would like to request are:
The academic accommodations made for you will be based on review of the documentation you submit. The university retains clinicians responsible for each area of accommodation; physical, learning/cognitive or psychological. The information on this form will aid those clinicians in determining reasonable accommodations.
All information submitted is considered confidential.
Please submit your documentation to:
Gwenn Smaxwill
Rabb School
Disability Coordinator
MS 084 415 South Street Waltham, MA 02453
smaxwill@brandeis.edu
Phone: 781-736-3424
Fax: 781-736-8124
Submit
