Request for Accommodation Form

Request for Accommodation Form

Complete this form for any food allergies, dietary restrictions, translation, interpretation, educational accommodations (IEP, 504), ADA, disabilities, and other special needs.
The National FFA Organization is committed to providing equal access to our events and activities for all people. Use this form to request accommodation or assistance at least 30 days before your event. All information submitted in this form will be kept confidential. Our staff will review the request upon receipt and contact the requestor with additional information.

The organization cannot guarantee accommodations or assistance if a form is received less than 30 days before an event.
Are you completing this request for:*
Participants Information:
Reason for completing this form; Please select all that apply*

ADA Accommodation RequestAllergy Notification (Milk, Eggs, Fish, Shellfish, Tree Nuts, Peanuts, Wheat, Soybean, Sesame, other)Educational Plan AccommodationMedical AccommodationSpecial Dietary RequestSpecial Request/AccommodationTranslation/Interpretation RequestOther
Please list allergy*
Identify the exposure that causes the reaction*

a. Ingestionb. Injectionsc. Inhalationd. Skin ContacOther
Please explain the type of exposure that causes the reaction (ingested, contact, inhaled, environmental)*
Today's Date*

MonthDayYear
Date
Participant's Name*

Participant First NameParticipant Last Name
Participant's Email*
example@example.com
Participant's Phone Number*
Parent/Guardian’s Name, if participant is under 21 years of age:

P/G First NameP/G Last Name
Parent/Guardian’s Email
example@example.com
Parent/Guardian’s Phone Number
State*
FFA Chapter Name*
FFA Chapter ID*
ZZ0101 (state abbr. 4 digit number)
Advisor’s Name*

Advisor First NameAdvisor Last Name
Advisor’s Phone Number*
Advisor’s Email*
example@example.com
National FFA Program or Event: Select all that apply*

Agriscience FairAmerican FFA Degree RecipientAmerican StarCareer/Leadership Development EventsILSSONational Chapter AwardNational FFA BandNational FFA ChorusNational FFA ConventionNational FFA TalentNational Officer CandidateNew Century Farmer (NCF)Next Gen ConferenceProficiency AwardsState Officer SummitWashington Leadership Conference (WLCOther
Please select the specific event*
Do you need translation for all event/ program materials or specific materials? Please choose all that apply below*

Workbooks/Learn booksTests/ExamsHandbooksVideosOnline OrientationsOther
Please clarify the interpretation support requested.*
What language and dialect are being requested?*
Questions to Clarify Accommodation(s) and/ or Assistance Requested
Please describe the special request/accommodations you are requesting. If request is allergy/dietary related, explain in detail the concern.*
If you have received accommodation(s) for previous FFA events, please list the accommodation(s) you have received.*
Documentation of Disability/Medical Condition/Allergy:
Please provide documentation of the specific diagnosis and limiting nature of the disability/medical condition/allergy by a board certified medical doctor, psychologist, or psychiatrist. Attach a PDF version of this documentation to your reasonable request for accommodations form.
Attach a PDF version of your specific diagnosis and limiting nature of the disability documentation provided by a board certified medical doctor, psychologist, or psychiatrist.

Browse Files

Cancelof
Form Submission
Name of the Individual Submitting Request*

First NameLast Name
Relationship to the Participant:*
Email*
example@example.com
In Office Use
Documentation of Action Taken
Should be Empty: