Fillable Accommodations Request Form (Jacksonville University)

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Accommodations Request Form (Jacksonville University)

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File type: PDF

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JACKSONVILLE UNIVERSITY
DISABI LITY SUPPORT SERVICES
ACCOMMODATION REQUEST FORM TERM ___________
Student Name: _______________________ Major.__________ _______________
Student Id #:___________________________ Status: Frsh___ Soph___ Jr___ Sr___ Grad___
E-Mail Address: _____________________________Telephone: _________________
If you have an online class, please check the ONLINE box below in order for the office of DSS to send the
letter directly to your professor.
Course Id
Online
Professor’s Last and First Name
Received by: ____________________________
Letters prepared by: ____________________________ Date: _________________________
Date Stamp
No changes in Accommodations
Student Signature
SUMMER 2019
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Accommodations Request Form (Jacksonville University)

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Completed 22 July 2020

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