FACULTY ACKNOWLEDGMENT FORM

STUDENT:
YEAR/TERM:

By signing below, you are indicating that you:
• have read the Disability Resources Letter to Instructors for this student regarding your class;
• have discussed with the student (or will soon) his or her needs and how to implement the accommodations described in the letter; and
• understand that you may contact Disability Resources to clarify questions, resolve problems, and discuss creative strategies to help this student succeed in college.

If you have any questions about these accommodations, please call Disability Resources at
(541) 463-5150.

_______________________________________________________
Class Title
_______________________________________________________
Instructor Signature
_______________
Date

_______________________________________________________
Class Title
_______________________________________________________
Instructor Signature
_______________
Date

_______________________________________________________
Class Title
_______________________________________________________
Instructor Signature
_______________
Date

_______________________________________________________
Class Title
_______________________________________________________
Instructor Signature
_______________
Date

_______________________________________________________
Class Title
_______________________________________________________
Instructor Signature
_______________
Date

_______________________________________________________
Class Title
_______________________________________________________
Instructor Signature
_______________
Date

_______________________________________________________
Class Title
_______________________________________________________
Instructor Signature
_______________
Date