Academic Accommodation Request

Academic Accommodation 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 academic accommodations on campus. To download the PDF, right click on the form and click "Print".
1. Guidance Checklist form (Must be completed by appropriate professional) Alternatively, you may upload your IEP or 504.
2. Professional's Letterhead Diagnosis & Reccommendation (Must be written by appropriate professional)
(This section to be completed once all required documents are completed and ready for submission.)
Student Name*

First NameLast 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. Guidance Checklist form OR IEP/504 File Upload*

Cancelof
2. Professional's Letterhead Diagnosis and Recommendation File Upload*

Cancelof

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 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].*

YesNo
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*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

Academic Accommodation Request - Required Forms

Consent Waiver