RETURN THIS FORM TO THE DISABILITY RESOURCE CENTER, 123 Meyer Library, by April 14, 2000. If you have not previously met with or spoken to a staff member of the Disability Resource Center, please do so before returning this request.

For Office Use:

I have reviewed this disability exemption request.

Will the student have an attendant?
 Yes, a student
 Yes, a non-student
 No 

Recommendation: 

Roomtype: 

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Physical Modifications or Location:

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Additional Information: 

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