Academic Coaching Program Application

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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 [email protected] 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
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