Please read carefully and initial each statement below to indicate that you authorize the Lake Superior State University Office of Accessibility Services to make arrangements for accommodations on your behalf.
The LSSU Office of Accessibility Services holds endeavors to preserve the confidentiality of students' disability information. Professors or other school officials may request information about the impact of a student's disability that may relate to safety needs or a student's ability to learn. Holding safety paramount, the Office of Accessibility Services will only share information with other school officials when appropriate and will carefully balance a student's request for confidentiality with any request for information about the student's accommodation needs.
I authorize the LSSU Office of Accessibility Services to discuss my disability-related needs with LSSU staff.
I authorize the administrative staff of the Office of Accessibility Services to exchange information as needed with the following individuals, LSSU departments, practitioners, or agencies to enable the office to provide appropriate accommodations for me. (Optional)
I permit the LSSU Office of Accessibility Services to share information regarding my testing accommodations with LSSU Testing Services.
I agree to adhere to the Testing Services Code of Conduct and Policies.
I understand that under the Federal Education Rights and Privacy Act of 1974 (FERPA), only authorized LSSU staff may have access to my records without my written consent or when required by legal statutes.
I understand that this authorization will expire two (2) years from today's date. This consent may be revoked at any time, but this will not affect information previously released under this authorization.
I understand that once information is released, Lake Superior State University cannot control its use or further distribution by outside entities and agree not to hold the university responsible for such actions.
Upload your medical documentation, a copy of your Individualized Education Plan (IEP), 504 Plan, or any other Accessibility Services forms here.
I certify that all information I have provided is true and accurate to the best of my knowledge. I understand that intentionally providing false or misleading information may result in my being ineligible for services and may also result in an LSSU Student Code of Conduct violation.
If you have reviewed your information and are ready to submit your form, please click the button below.