Student Accommodation Request

Student Accommodation Request — Form Fields

This education template includes 6 fields. Allow students with disabilities or special needs to formally request academic accommodations. Captures the nature of the need, supporting documentation, and requested adjustments. Ensures students receive appropriate support in compliance with accessibility policies. Free to customize and use on ZenBuild.

• Student Full Name (text, required)
• Student ID (text, required)
• Type of Disability or Need (dropdown selection, required) — options: Physical / Mobility, Visual impairment, Hearing impairment, Learning disability (e.g. dyslexia, ADHD), Mental health condition, Chronic illness, Other
• Accommodations Requested (checkboxes, required) — options: Extended time on exams, Separate testing room, Note-taking assistance, Alternative format materials, Preferential seating, Assistive technology
• Do you have supporting documentation from a healthcare provider? (multiple choice, required) — options: Yes – I will attach it, Yes – I will submit it separately, No – I need guidance on obtaining documentation
• Upload Supporting Documentation (file upload, optional)