Student First Name * Student Last Name * Student OSU Email * Student Mobile Phone Number * Today/s Date * Year Year20222023202420252026 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Appointment date I acknowledge that, for the purpose supporting my academic progress, I am providing permission to Disability Services to share information about my academic progress and accommodations with: * Name Relationship * Relationship Effective Date * I understand that this permission will remain in effect until I leave the university, unless revoked in writing to the Office for Disability Services, CFAES Wooster Campus/Ohio State ATI. Permission Cancellation * I understand that this permission can be cancelled at any time, in writing, to the Office for Disability Services, CFAES Wooster Campus/Ohio State ATI. Records Notification * Records Notification - Your Disability Services Parent/Guardian permission form will remain on file in this office for a period of 6 years after leaving the university, after that time, the documentation is destroyed. CAPTCHAThis question is for testing whether you are a human visitor and to prevent automated spam submissions.
