This form is simply for notification purposes; determination of reasonable accommodations will take place upon receipt and review of documentation you provide.

Please answer questions on the back side of this form and return to:
Lynn Waldman, Director of Academic Program Support and Disability Services, 105 McGregory Hall, Colgate University, 13 Oak Drive, Hamilton, NY  13346.
 

Once I receive your form, I will contact you to introduce myself and to answer any questions you may have.  Please feel free to contact me if there is anything I can do to assist you.
 
Thanks much.
Lynn Waldman
 

 
 
Date:_______________________
 
Name:________________________________________________________________
 
Address:______________________________________________________________
 
Telephone:___________________________________________________________
 
E-Mail:________________________________________________________________
 
Nature of Disability:
 
 
 
 
What accommodations do you anticipate requesting?  Please be as specific as possible.