I submit this completed application as a portion of the eligibility determination process for registration with Services for Students with Disabilities as a student with a disability requesting academic accommodations for equal access at Purdue Fort Wayne.
Name and credentials of qualified professional who diagnosed or treated your disability.
LEGIBLE COPIES OF THE COMPLETE MEDICAL DOCUMENTATION OR
ASSESSMENT REPORTS MUST SUBMITTED TO THE SSD OFFICE (WU 113). PLEASE HAVE MEDICAL DOCUMENTATION FAXED TO 260-481-6018.
Academic Accommodations you are requesting at Purdue Fort Wayne: