Accommodation Request Form

This form should be used by Kenzie Academy students and learners who believe they have a disability and wish to request nonacademic or academic accommodations. The first step in receiving consideration for accommodation is to submit a request.


New Step

Documentation: Acceptable documentation is an IEP, 504 plan, and medical note from a mental health or medical provider stating diagnosis and/or accommodation needs.

Medical or mental health recommended accomodation on prescription pad or letterhead from licensed physician or counselor, IEP, or 504 plan accommodations page. Do not upload entire 504 plan


Kenzie Academy's goal is to protect the privacy of each student. In the course of work with each student, however, it is sometimes helpful to discuss their situation with an instructor, facilitator, or team member.

The student by clicking "I agree" gives Kenzie Academy their permission to refer their name and discuss accommodation needs with instructors and Kenzie staff, but only for the purpose of providing services.


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