Request for Accommodations
Initial request for accommodations from Quantic School of Business & Technology and Valar Institute. Please click here to review the Accessibility & Accommodations Policy thoroughly.

Documentation related to your disability must also be sent to accommodations@quantic.edu or accommodations@valar.quantic.edu after completion of this form in order to verify your request. Documentation must be as current as possible, and documentation written in a language other than English must be translated. Documentation must support the need for accommodation based on a disability. It can include, but is not limited to: A statement or report from a licensed healthcare professional (must include name, title, and professional credentials), Individualized Education Plan (IEP) or 504, Military or veteran records confirming disability, Documentation recording disability and accommodations from a previous school or university. All files must be uploaded in PDF format.

All personal documentation relating to accommodations and disability documentation will be kept confidential; however, relevant faculty and administrative staff members may be informed in order to provide accommodations.

A printable PDF version of this request form is available upon request.
Sign in to Google to save your progress. Learn more
Email *
Name *
Program *
Phone Number *
Class of_______. (ex. Class of July 2023) *
Please identify the nature and extent of your disability as it relates to your request for accommodations (e.g., medical condition, ADHD, learning disabilities, psychological disabilities, sensory disabilities, physical/mobility disabilities, temporary conditions, etc.).  Please specify the specific diagnosis and the date of the original diagnosis. *
How does your disability impact your ability to complete coursework or other program requirements or your ability to access services?  How does your disability impact your daily activities outside the classroom? *
Describe the accommodation(s) you would like to request from Quantic, the rationale of the request, and the timeframe during which you are seeking accommodations (be as specific as possible). *
What accommodation(s), if any, have you received from your previous school or university? *
I understand that I am responsible for requesting accommodations from Quantic School of Business and Technology and Valar Institute, and that I will be required to provide documentation of my disability/ies to support my request for accommodation at my own expense in order for my accommodation request to be considered. I agree to provide all documentation in a timely manner and am aware that it will take time for personnel to provide accommodations. I am aware that if I need to request a new accommodation, I must provide updated documentation to the Coordinator of Compliance and Student Affairs.  I am aware that it is my responsibility to communicate directly with faculty and staff regarding accommodations, and stay in communication about such accommodations. I am aware that it is my responsibility to contact the Coordinator of Compliance and Student Affairs at accommodations@quantic.edu or accommodations@valar.quantic.edu if I am having any difficulties receiving my accommodations. I am aware that accommodations are not retroactive. I agree to comply with the policies and procedures related to accommodations. *
Required
By typing my name and electronically signing, I guarantee the information provided is correct to the best of my abilities, and hereby give permission to the Quantic School of Business and Technology and Valar Institute to release information to appropriate personnel to aid in the consideration and implementation of disability accommodations. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Pedago LLC.

Does this form look suspicious? Report

Google Forms