ESA Request - Required Forms
Please find below the required forms that must be downloaded, completed, and then submitted through this electronic process to aid us in determining your eligibility for an ESA on campus. To download the PDF, right click on the form and click "Print".
1. Professional's ESA Request form (Must be completed by appropriate professional)
2. Student's ESA Request form (Must be completed by student)
(This section to be completed once all required documents are completed and ready for submission.)
Student Name
*
First Name
Last Name
FSC ID Number
*
Mocs Email
*
example@mocs.flsouthern.edu
Entry Year at FSC
*
Year (XXXX)
Phone Number
*
Please enter a valid phone number.
1. Professional's ESA Request form File Upload
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2. Student's ESA Request form File Upload
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ESA Policy
Please review the attached ESA Policy to further understand the rules and responsibilities of having an ESA on campus. Note that this will be reviewed again in greater detail with the SDS team once all of the required documents are submitted after being found eligible.
ESA Policy
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Consent Waiver
By signing this consent form, you are authorizing Student Disability Services to send a description of your approved academic accommodations to your course instructors and academic advisor, and your residential accommodations to Community Living, Campus Safety, and other need-to-know community members. For academic accommodations, it is your responsibility to discuss with your instructors how the accommodations will be implemented in the classroom. If you make changes to your schedule after you sign this consent waiver, please notify us so that your new instructors can be informed as soon as possible. A signed Consent Waiver will allow the Office of Student Disability Services to release your accommodation information for the 2024-2025 academic year. You are responsible for contacting SDS if you would like to REVOKE permission for accommodation information to be sent.
If you are seeking an Emotional Support Animal/Service Animal/Service Animal In Training, you agree that we may release this information to roommates/suitemates, Community Living, Campus Safety, and other community members who may need to know that this accommodation is being sought or has been approved.
*
Yes
No
Please provide contact information of any other person(s) you are permitting to receive information about your accommodations:
Date
*
-
Month
-
Day
Year
Date
Signature
*
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