• Program for Deaf Adults: Accommodation Services Request Form


    Your request for accommodation services will be emailed to Program for Deaf Adults. You will receive an email copy of your request and be notified once accommodation services have been arranged. Please notify pda@lagcc.cuny.edu at least 48-hours in advance if you need to cancel services. If you have any questions or concerns, please contact: pda@lagcc.cuny.edu



    First Name  
    Last Name(s):  
    Videophone/ Home Phone:  
    Cell Phone:  
    Email*:  



    Additional Information



    Please select the type of accommodation services you are requesting for the course/event: *

                                                                                            


    Course Name or Event Name: *

     


    For Notetaking, Tutoring and Captioning only, please provide course section number: *

     


    Is this a one-time or ongoing request for services? *
    (one-time: campus/class event, off-campus field trip, meeting with professor, etc. OR ongoing: weekly meetings etc.)

                    


    Start date of course/event

    Month:  
    Day:  
    Year:  


    End date of course/event

    Month:  
    Day:  
    Year:  


    Time requested for course/ event  *
    i.e.: 3:00-4:30PM

     


    Please provide any additional information for the course/event: