Accommodation Request Form

Thank you for choosing UC Scout. Our team is committed to supporting and accommodating our students throughout their academic journey.

What is an accommodation? Accommodations in education are changes to the environment, curriculum, or equipment that help students with disabilities access course content and complete tasks.

This form is for students who need to request accommodations for UC Scout On Demand courses. Please fill out this questionnaire and upload one of the following documents in order to request an accommodation:

504 Plan
College Board Letter
Individualized Education Program (IEP)
Individualized Service Plan - Private Schools (ISP)

The document must have a signature from the student's parents/guardians and a school representative. Electronic signatures are acceptable. Check your form now before uploading to ensure that these signatures are present. If they are not, this will delay the process as we will need to reach back out to you to request the signatures.

If you do not have one of the documents listed above and believe your student needs accommodations, then we recommend connecting with your school to start a dialogue about requesting this documentation. This request will not be approved without one of the documents listed above.

After the request is submitted, our Accommodations Team will review your request and follow up within 3-5 days to provide a list of the reasonable accommodations that we can implement.

Additionally, all students are welcome to participate in On Demand courses but we cannot implement accommodations without signed official documentation.

If you have questions, please reach out to ucscoutaccommodations@ucsc.edu.

Student Email

Student First Name

Student Last Name

Parent's Email

Phone Number

Course Name

Section Number (e.g. GEOM141-005)

Course Term

What documents are you submitting?

Select all that apply

Have you previously submitted an approved Accommodations Request with documentation for an On Demand Course?

If you select "Yes" but your response is not accurate then this will increase the amount of time needed to process this request. We need you to upload the necessary documentation unless you have previously done so.

Please upload your documents here (If the document is password protected include this in the notes section below)

We can only apply accommodations for students who submit the appropriate signed documentation. If the documentation does not meet the necessary requirements then accommodations WILL NOT be applied to the student’s course.

Additional document upload

Which page(s) of your document are your accommodations listed on?

Which accommodations from your document would you like to be applied to your course?

Contact Information