I authorize Penn Foster and its agents to (i) contact the physician(s) listed above to request and obtain all medical information related to the current health condition(s) for which I am requesting a reasonable accommodation, and (ii) disclose to Penn Foster’s accrediting or licensing organizations, if requested by those organizations in connection with a required accreditation/licensing-related audit of Penn Foster, the information that I have provided in connection with this form.
Individualized Educational Plan (IEP):
(Must be issued within 5 years of the current date)
1. Please provide where indicated below the name and contact information of the School/Organization who developed your IEP.
2. Please attach documentation provided by your previous school/organization describing your condition or limitation that prompts this request for accommodation.
3. IEP must be signed by an official of the issuing school.
4. Date IEP was issued or last evaluation date.