Fillable Disabled Student Program and Services Please print and (West Los Angeles College)

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Disabled Student Program and Services Please print and (West Los Angeles College)

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Disabled Student Program and Services
Please print and fill out completely, pending Counselor/ LD Specialist approval accommodation letter(s) will
be sent to your instructor and emailed to you.
Date
Term/ Year
LACCD Student ID
Student Name
@student.laccd.edu
LACCD E-mail Address
Classes for which you are requesting accommodations: Entire Schedule
Class Number
Course
Instructors
Name
Example 13127
Math 227
West, L.
Approved Declined Other (See Notes)
Notes/Comments
Counselor Signature Date
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Disabled Student Program and Services Please print and (West Los Angeles College)

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Completed 7 May 2021

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