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

Name(Required)

First Last

Video Phone / Home Phone

Cell Phone(Required)

Email(Required)

Additional Information

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

American Sign Language interpreting services

Tutoring

Notetaking

Captioning

Other

Course Name or Event Name:(Required)

For Notetaking, Tutoring and Captioning only, provide course section number:(Required)

Is this a one-time or ongoing request for services?

One Time

Ongoing

(one-time: campus/class event, off-campus field trip, meeting with professor, etc. OR ongoing: weekly meetings etc.)

Start date of course/event

End date of course/event(Required)

Start Time requested for course/ event

End Time requested for course/ event

Please provide any additional information for the course/event:

Comments

This field is for validation purposes and should be left unchanged.

Program for Deaf Adults: Accommodation Services Request Form

Additional Information