Request for Disability Services
*All Interpreter Request must be submitted 3 days prior to the scheduled event *
TSC ID *
Your answer
Student/Staff Name *
Your answer
E-Mail Address *
Your answer
Phone Number *
Please enter number in the following format: (###) ###-####
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
College Major *
Your answer
Are you receiving services from the following agencies?
What is your disability?
To equalize my chances of success in the classroom, I would benefit from the following accommodations:
Your answer
I give my permission for the above information to be made available to my instructors, the college administrator, and other individuals employed by Texas Southmost College who require information to provide for my educational needs. *
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