Non-Academic/Academic Accommodations Request Form

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Academic Achievement Center
1844 Commonwealth Avenue
Newton, MA 02466

Stephen Hawthorne
6172432212
shawthorne@lasell.edu

Non-Academic/Academic Accommodations Request Form

If you are a student with a documented disability, you may benefit from certain academic accommodations. If you believe you qualify, or have questions about qualification, and would benefit from appropriate and reasonable accommodations, the Director of Accessibility Service and Academic Support, Stephen Hawthorne, is available to discuss options with you.

Please fill out this form, including submitting relevant documentation. If you do not yet have documentation ready to submit, you may complete this form and follow up when your documentation is ready to submit.

We strongly suggest that students submit documentation before the beginning of the semester, when possible.

The Director of Accessibility Service and Academic Support will contact you. Should you have questions about the form itself or any other aspects or requesting accommodations, please contact Stephen at shawthorne@lasell.edu or (617) 243-2212.

User Information

First Name:

Last Name:

Email Address:

Phone Number:

Phone Number(Alternate):

Address:

City:

State:

Zip:

Status:

New student

Returning student

Academic or Non-Academic?

Choose below which type of accommodation you are requesting

Please state the nature of your disability:

Please describe any disability services you received in a previous college / institution, if applicable:

Academic Accommodations

What academic accommodation(s) are you requesting at Lasell University?

List all documentation you are submitting with this form (please note: submit only a copy of your paperwork, while retaining any original documents)

Non-Academic Accommodations

Please list any non-academic accommodations you are requesting at Lasell University:

Please indicate how the requested accommodation(s) might impact your access to college facilities, programs, services and activities:

File Upload

Upload Documentation here:

Clinical / Diagnostic Specialist Contact(s)

Documentation can also be mailed directly to our office:

Lasell University

Attn: Stephen Hawthorne, Academic Achievement Center

1844 Commonwealth Ave., Newton, MA 02466

I grant permission to the Lasell University Academic Achievement Center (AAC) Director to discuss my disability with the listed contact(s).

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