Student Accommodation Request

Empl ID

FSCJ Student number, numbers only, do not include the "S"

Please use your FSCJ email address

Phone Number

Cell/Alternate Phone Number

Campus/Coordinator Preference

My diagnosed disability falls into the following category

My specific disability is

How does your disability affect you academically? Student life in general, taking tests, studying, etc.

What accommodation(s) are you requesting and/or have received in the past?

Services are approved on a case by case basis and documentation of disability must support the requested accommodations. Student is responsible for notifying the Student Support Services Office (SSSO) of any changes in schedule or instructor, and with any concerns that may arise with their accommodations as soon as possible. Student must contact SSSO each semester to request accommodations for each term. By agreeing below you acknowledge that you understand and agree to the OSSD policy and procedures as outlined above.

Upload supporting document(s)

If you do not have documentation of your disability you will be unable to submit this form. If you have any questions please email accommodateme@fscj.edu .

County of Residence

Voter Registration Application

https://registertovoteflorida.gov/

Document Title

Student Accommodation Request

Student Information

Specific Accommodation Information

Document Information