TSU Office of Disability Services
The following Tennessee State University form is considered confidential and will not be discussed outside of the Office of Disability Services without your permission.
Date of Birth
Contact Phone Number
Physician's Name and Number
In Case of Emergency Contact
Are You Receiving Vocational Rehabilitation Services
If you Answered YES, to the Question Above, What is your Counserlor's Name and Phone Number?
By submitting this form, I understand that in the event that my needs change during the semester it is my responsibility to notify the Office of Disability Services. I give my consent for DS to discuss my needs related to my impairment with my parent(s), faculty/staff or administrators as they deem necessary in their efforts to arrange appropriate academic accommodations for me to ensure my equal opportunity at the university.
I do not consent
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