Students with Disabilities: Accommodation Permission for Faculty Notification

THIS FORM MUST BE SUBMITTED EACH SEMESTER ACCOMMODATIONS ARE NEEDED

Semester *This question is required.

Academic Year *This question is required.

Student Name *This question is required.

Student Email *This question is required. This question requires a valid email address.

Date *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

I grant permission to the PSR Accessibility Services Office (ASO) to notify the following faculty members (including advisors, course instructors, examiners, and/or committee members) of the accommodations ASO has approved for me, in order that they may assist in the implementation of accommodations to my disability.

I understand that I need to contact each faculty member and arrange with them how these accommodations can be implemented in their particular course, examination, or defense.

By entering my name, I accept the conditions stated above *This question is required.

Please provide your course and faculty registrations for this semester *This question is required.

Space Cell	Faculty Name	Role (e.g.prof, Advisor)	Faculty email	Full Course Number (ABCD-nnnn)	School	Course Name
1	1: Faculty Name	1: Role (e.g.prof, Advisor)	1: Faculty email	1: Full Course Number (ABCD-nnnn)	1: School	1: Course Name
2	2: Faculty Name	2: Role (e.g.prof, Advisor)	2: Faculty email	2: Full Course Number (ABCD-nnnn)	2: School	2: Course Name
3	3: Faculty Name	3: Role (e.g.prof, Advisor)	3: Faculty email	3: Full Course Number (ABCD-nnnn)	3: School	3: Course Name
4	4: Faculty Name	4: Role (e.g.prof, Advisor)	4: Faculty email	4: Full Course Number (ABCD-nnnn)	4: School	4: Course Name
5	5: Faculty Name	5: Role (e.g.prof, Advisor)	5: Faculty email	5: Full Course Number (ABCD-nnnn)	5: School	5: Course Name
6	6: Faculty Name	6: Role (e.g.prof, Advisor)	6: Faculty email	6: Full Course Number (ABCD-nnnn)	6: School	6: Course Name
7	7: Faculty Name	7: Role (e.g.prof, Advisor)	7: Faculty email	7: Full Course Number (ABCD-nnnn)	7: School	7: Course Name

Students with Disabilities: Accommodation Permission for Faculty Notification

COURSE INSTRUCTOR INFORMATION