620.343.4600 | 800.711.6947 | fax: 620.343.4610 www.fhtc.edu 3301 West 18th avenue | emporia, Kansas 66801
COURSE NOTIFICATION SHEET | FORM FOUR
CONFIDENTIAl FORM
To: Vice President of Student Services
Flint Hills Technical College
Name: Social Security Number:
Address:
Date: Home Telephone: Work Telephone:
Each semester you will need to notify the Vice President of Student Services after registration about what classes you are enrolled in. Please ll in the
appropriate information below or e-mail this information to lkirmer@fhtc.edu.
PROGRAM INFORMATION
Term: Fall Spring
Program of Study:
Instructor(s):
To le a request for accommodation, you must contact the Vice President of Student Services and complete the appropriate information on the
Request for Accommodation and Academic Support form and return it to the Vice President of Student Services.
You must also le a Disability Information Sheet and a signed Release of Information form that will allow the Vice President of Student Services to
communicate with the appropriate personnel in order to address your particular accommodation.
IT IS THE RESPONSIBILITY OF THE INDIVIDUAL STUDENT TO REQUEST ACCOMMODATION OR AUXILIARY AIDS AT LEAST SIX (6) WEEKS
BEFORE CLASSES, PROGRAMS, OR ACTIVITIES BEGIN, OR AS SOON AS REALISTICALLY POSSIBLE.
Rev. 11/25/2013
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