Public Accommodation Request

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Student Information

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First Name

Last Name

Middle Name

Student ID

FIT Email

Please use your FIT issued email address

Phone Number

Preferred Pronouns

Select all that apply

If you select Other above please tell us your preferrence

Accessibility Specific Information

Instructions: There is much variability within each accessibility category, and therefore, the type of accommodations needed can vary significantly. Below, you will find descriptions of the various types of disabilities recognized in the United States. Student needs vary according to each individual. Therefore, it is important for the participating student to clarify the particular accommodations she or he requests

My diagnosed disability falls into the following category

What is your specific disability diagnosis?

My accommodation request is for (select all that apply):

How does your disability affect your participation on campus or in the classroom?

i.e. classroom, dorms, dining hall

What accommodations have you used previously?

Documentation Delivery

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Public Accommodation Request

Student Information

Accessibility Specific Information

Document Information