OfficeofAccessib ility
Face Covering Accommodation Request Form
Important information about this request
The Face Covering Documentation Form must be completed by a qualified professional and submitted
with this request
Reasonable accommodations will be determined through an interactive process which includes request,
documentation, assessment of need, and conversation with college representatives
Diagnosis of a medical condition does not guarantee a request or accommodation will be approved
Recommendations from qualified professionals will be considered, however the college will make the
final determination of what is reasonable for each individual situation
If a reasonable accommodation is not available, students may not meet the standard to be on campus
As per Executive order 20-81 businesses are obligated to mitigate or eliminate exposure to people who
cannot wear or refuse to wear a face covering
All information related to this request is confidential
Section I
Last Name:_____________________________ First Name:______________________________
Tech or Star ID:__________________
Email Address:_______________________
Mailing Address:______________________________________ City/State/Zip:________________________
Phone Number (Home):________________________
Phone Number (Cell):___________________________
Campus (check all that apply)
Anoka Technical College ARCC Cambridge ARCC Coon Rapids
If requesting face covering accommodations at both Anoka-Ramsey Community College and Anoka Technical
College please acknowledge the following statements:
I give my consent to the representatives of Anoka-Ramsey Community College and Anoka Technical College
to consult regarding my request for face covering accommodations, share this request form, and any medical
documentation related to this request.
I understand that I may need to engage in the interactive process with both campuses individually if my
specific request and circumstances requires.
www.Anokatech.edu
