Academic Accommodation Renewal Request

Academic Accommodation Renewal Request — Form Fields

This education template includes 10 fields. Request renewal of an existing academic accommodation for a new semester or academic year. Free to customize and use on ZenBuild.

• Student Full Name (text, required)
• Student Email (email, required)
• Student ID (text, required)
• Academic Year or Semester (text, required)
• Program of Study (dropdown selection, required) — options: Undergraduate, Graduate, Professional Degree, Certificate, Non-Degree
• Current Accommodations (Brief Description) (text, required)
• Has Your Condition Changed Since Last Request? (multiple choice, required) — options: No change, Improved, Worsened, New condition added
• Updated Documentation or Notes (long text, optional)
• Accommodations Being Renewed (checkboxes, required) — options: Extended test time, Reduced-distraction testing, Note-taking support, Captioning/ASL interpretation, Alternative format materials, Flexible attendance
• Additional Information (long text, optional)