Intake Form

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Student Information

Please enter your information

If you are prospective student please contact Student Accessibility Services at 717-358-3989. 

Prospective students please enter "0"
Please use your college issued email address
Permission to Text RemindersRequired
Please indicate yes if SAS may text you reminders of upcoming appointments or exams.
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Specific Accommodation Information

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Did you receive accommodations in high school?
Are you requesting any of the following accommodations?




Is there a practitioner we may contact for further information?
Services with Student Accessibility Services are limited without official documentation.

Permission to Release Information

I give my permission for the release and discussion of information regarding my disability and accommodations between the Director of Student Accessibility Services and relevant personnel at the College such as, but not limited to, the personnel in the Student Wellness Center, Counseling Services, Office of the Registrar, Office of Housing, academic dean, academic advisor, International Studies, Dean of the College and faculty for classes in which I am either currently enrolled or classes in which I am registered, as warranted appropriate by the Director of Student Accessibility Services who will only release information on a “need to know basis” as required by law.  I also give permission to the Director of Student Accessibility Services to speak with the practitioner(s) treating the condition for which I am requesting accommodations.  I understand that the information may only be shared to utilize preparation/provision of reasonable accommodations or auxiliary aids and services for which I am eligible.  By signing this form, I understand that this permission to release information remains valid for the duration of my tenure at Franklin & Marshall College and that I may rescind or amend this agreement at any time. 

AgreementRequired

Permission to Release to Parent or Guardian

I give permission to release and discuss my academic accommodations and academic progress with my parents/guardian. By signing this form, I understand that this permission to release information remains valid for the duration of my tenure at Franklin & Marshall College and that I may rescind or amend this agreement at any time.

I agree that my information can be released to my parent or guardian