GMS Accommodation Release Form

You have been approved for accommodation(s) by Boston University’s Disability & Access Services. In order to receive these accommodations, please provide the following information about the courses for which you wish to receive services. NOTE THIS FORM MUST BE COMPLETED EACH SEMESTER TO RECEIVE SERVICES.

Name*
First Last
Email*
BU ID#*
GMS Program*
Program Director*
Program Director Email*
Course Information*
Course Number Course Director Name Course Director Email
Consent*
I give permission to disclose my accommodation(s) to the above individuals.

Course Number	Course Director Name	Course Director Email