Please enter your contact information.
UIN*

Preferred Name*

Email*

Phone Number*

Please enter contact information for your instructor.

Department/College/Unit*

Instructor's Name*

Instructor's Email*

Select the response that most closely fits the reason you are requesting a review of your instructor’s implementation of your current Letter of Academic Accommodations.
Instructor has not implemented my academic accommodations at all.Instructor has only partially implemented my academic accommodations.Instructor has communicated that the requested accommodation(s) would materially alter the course.Other.
If you selected "Other" above, please briefly describe the reason for your request.

Rationale*Please explain why you believe your instructor’s implementation decision about your academic accommodations is incorrect. Below, please upload any documentation, including emails or other documents, that support your position.

Remedy* What remedy or solution are you seeking?

Please provide information about the actions (if any) that you have taken to resolve your concern.

Briefly describe any additional actions (if any) that you have taken (Ex. Spoke to instructor, emailed instructor, spoke to Access Specialist, etc.), along with the dates for these actions, the outcome of the action, and any evidence to support that these actions were taken. (Please note that an outcome could include a lack of response to the action taken).

Please provide any additional information and supporting documentation that you believe may be helpful during the AIIR review process.

Additional Information

File Upload

Please upload your Letter of Academic Accommodations and any other documents or emails that support your request. You may upload up to three documents. Note: Do not provide any medical documentation with your submission.
Document 1

Document 2

Document 3