The University of Delaware’s Academic Coaching Program is a fee-based, cost-above-tuition, program designed to foster academic success for students with a documented disability. The Program offers weekly individualized academic/life skills coaching and support. Please email your application to dssoffice@udel.edu or mail to: ATTN: Lee Robert K. Plenn, M Ed. - Academic Coaching Program, Disability Support Services, 240 Academy Street, Suite 130, Newark Delaware, 19716 STUDENT INFORMATION Last First Middle Initial Local Address Apartment # City State Home Phone Cell Phone Student ID# Email Address Signature Maiden Name (if any) Zip Other Phone Date *Students with a disability not accepted into the Academic Coaching Program can/will still receive accommodations. 1|Page Compose a personal statement (about 250 words) of your strengths, personal/academic interests and thoughts about the ways you feel this program may provide the most help to you. 2|Page