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Testing Request Form
Temporary Disability
Temporary Accommodation
This form may be used for any temporary condition, including those associated with COVID-19. This form must have supporting documentation attached in order to be submitted.
Last Name
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First Name
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Hilbert College Email Address
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Reason for accommodation (check one)
Medical Issue
Personal Issue
Temporary Condition
Explanation
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Begin Date
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Anticipated Date of Return
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Accommodation Request
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Indicate any accommodations you might need during this time period.
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Documentation
Please upload supporting documentation.