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Request for Assistance with Temporary Medical Conditions Form | Bismarck State College

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Request for Assistance with Temporary Medical Conditions Form

* First Name:  
* Last Name:  
* Student ID Number:  
* BSC Email Address:  
* Primary Phone Number:  
* Services Requested:
Please note BSC is unable to provide personal transportation
 
Please submit additional supporting documentation which includes:
  1. A statement from the physician (on letterhead) which indicates the academic/physical limitation due to the temporary condition and the approximate length of time the student will be impacted by the limitation, as well as,
  2. A copy of the student's current class schedule
The above items can be delivered by any of the following methods:
  1. Drop off at the Office for Student Accessibility Office located in the Student Union 120
  2. Mail to Bismarck State College for Student Accessibility, PO Box 5587, Bismarck, ND 58506-5587
  3. Fax to 701-224-5630 (call 701-224-2696)
  4. E-mail to bsc.accessibility@bismarckstate.edu or andrea.frantz@bismarckstate.edu