Disability Services Policies and Procedures Acknowledgement Form
Please review and acknowledge that you have received, read, and understood the Disability Services Policies and Procedures. Complete all required fields below.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Department or Role
Date of Acknowledgement
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
I acknowledge that I have received, read, and understood the Disability Services Policies and Procedures.
*
Yes, I acknowledge
Comments or Questions (optional)
Signature
*
Submit Acknowledgement
Submit Acknowledgement
Should be Empty: