First Name * Last Name * Class * P.O. Box * Phone Ext. * Email * I request a foreign language substitution because of my disability (i.e. learning disability or hearing impairment), which affects my language learning in these specific ways * I understand that the intent of the language requirement is to help me achieve a reasonable proficiency in a language new to me, and to introduce me to the culture of the country or countries in which this is the primary language. To the extent possible, I propose to meet the intent of the requirement by taking the following two courses (please specify the two courses by their department number and name): Course 1 Department Name: * Course Number: * Course Name: * Course 2 Department Name: * Course Number: * Course Name: *
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