Academic Accommodation Request - Required Forms
If you are requesting an academic accommodation, please complete the following form and submit for review.
Student Name
*
First Name
Last Name
FSC ID Number
*
Mocs Email
*
example@mocs.flsouthern.edu
Phone Number
*
Please enter a valid phone number.
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Disability Documentation Guidance Form
This form is to be completed by the healthcare professional. NOTE: An IEP/504 Plan can be submitted in place of the Guidance Form.
Please download the guidance form, provide it to your healthcare professional, and upload the completed form below. Alternatively, you may upload your IEP or 504.
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Professional's Letterhead Diagnosis & Recommendation
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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 2023-2024 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 academic/classroom accommodations, you agree that we may release your accommodation plan to your instructors and academic advisor. [NOTE: If you do not wish for us to share your accommodations with your advisor or faculty, please list those with whom you do NOT want us to communicate].
*
Yes
No
If you do not wish for us to share your accommodations with your advisor or faculty, please list those with whom you do NOT want us to communicate.
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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