Office of Disability Services (ODS)
Smith College School for Social Work
Accommodations and Services Request Form
● Please complete ALL SECTIONS of this form.
● A new form must be submitted for course accommodations each summer.
● Please remember to also complete the Field Accommodations section of this form to request
academic and placement related accommodations.
● Medical and/or educational information about your disability must be provided to ODS.
● Requests for new or changed accommodations will be reviewed before approval. You will be
notified if additional documentation is needed.
● Retroactive accommodations cannot be provided.
● If your address (permanent or on-campus) changes, please notify ODS immediately.
Accommodation request for:
Name (include the pronoun you use) House:
Are you living off-
campus this summer?
Please explain your disability and/or the challenges you are experiencing:
Documentation provided to the Office of Disability Services? Yes No