Academic Resource Center
470 E. Lockwood Ave. Saint Louis, MO 63119-3141 USA
Phone: 314-246-7620 Fax 314-968-5919
www.webster.edu/arc
Home Campus: St. Louis, MO, USA
Request for Academic Accommodations
Date
Student ID#
Name
Preferred pronoun
Birthdate
Home Address
(Street)
(City) (State) (Zip)
Campus
Major
Minor
Advisor
Cu
rrent level of study:
Freshman
Sophomore
Junior
Senior
Graduate Student
Phone
Email
Pl
ease check all that apply:
Full-time Student
Part-time Student
Online Student
Active Military or Veteran
Vocational Rehab
If checked, counselor’s name and number
Notes/additional information
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