ASC Accommodations Profile
Please complete this form for the ASC to have on file.
Stetson University ID Number
Cell Phone Number
How were you referred to the Academic Success Center?
Student Success Presentation
If Organization/Other, please specify
What are your strengths as a student?
What are your weaknesses as a student?
Disabilities and Accommodations
Please list any disabilities that have an impact on your academic work
Please check the area(s) below impacted by those disabilities
Please explain how you are affected by the disabilities indicated above
Please discuss academic accommodations or special considerations you have had in your previous schooling
(i.e., at your high school or at another college or university)
Please describe the accommodations you are requesting to receive here at Stetson
What other information would be helpful to the ASC staff to know about you?
By checking this box, I agree to allow the Director of the Academic Succes Center, or the Director's designee, to determine whether pertinent staff members should be informed of my disability information in order to fully support my needs.