Student Accommodation Services Request Form Home Student Life Student Services Students with Accommodation Services (SAS) Student Accommodation Services Request Form Student Experience Be INSPIRED Business Associations Business Partners Educational Consultants Partnership Application Diversity and Inclusion Housing Housing FAQs On-Campus Dining Student Center Student Clubs Student Club Guidelines Student Events Student Orientation New Student Orientation Form Commencement Ceremony Graduation Dinner Messages from Home Student Services Students with Accommodation Services (SAS) Student Accommodation Services Request Form Request for Accommodations Student Success Initiative Student Referral Form Faculty and Staff Referral Form Student Study Rooms Airport Pick-Up New Students Student Resources Health Insurance Health Clinics Student Discounts Useful Websites Internship Requirements Student Stories Transportation International Student Visa Information F-1 Reinstatement Change of Status to F-1 Transferring to FXUA is Easy! Bringing a Family Member Curricular Practical Training Optional Practical Training (OPT) ISS Applications I-20 Shipping Method ISS FAQs Career Center Make an Appointment Testimonials Post Graduate Employment & Internship Program Career Center Student Events Professional Resources Employment Resources Job Search Skills Student Employment CSM Employers Name:* First Last Student ID:*FXUA Email:* Phone Number:Date of Birth: Date Format: MM slash DD slash YYYY Academic InformationCurrent Class Standing:Choose an itemProspective StudentFreshmanSophomoreJuniorSeniorGraduate StudentTransferAre you currently enrolled in courses at Fairfax University of America?Choose an itemYesNoMajor or intended course of StudyChoose an itemSchool of BusinessSchool of Computer Information SystemsSchool of EducationSchool of Language StudiesSupport Services InformationMy diagnosed disability falls into the following category:Choose an itemAttention Deficit Disorder (ADD)Attention Deficitent Hyperative DisorderAutism Spectrum DisorderChronic Health DisabilitiesHearing ImpairmentsSpecific Learning DisabilitiesMobilityAnxiety DisorderNeurologicalPsychological/Psychiatric DisabilityMajor DepressionMajor Depression with PsychosisTraumatic Brain Injury (TBI)Visual ImpairmentPhysical/mobility impairmentNot Yet DiagnosedOtherDescribe in your own words the limitations caused by the condition you have namedDescribe how your condition affects your educational experienceWhat medications are you currently taking related to your condition(s)If taking medication(s) what are their side effects?Prior Support ServicesHave you received academic accommodations in another setting?Choose an itemYesNoSupport Services RequestedName the specific accommodations you are requesting and describe how they will enable you to be a successful student:Do you have any additional comments?Upload Support DocumentsUpload Support Documents attachment.General Disability Documentation Guidelines: Learning Disability Documentation Guidelines: If you have any questions/concerns about this, please e-mail: sas@viu.edu By clicking submit I understand the medical information I provided to the Student Accommodation Services shall be considered confidential. However, I also understand that limited disclosure to others in the University may be necessary in order to provide the services that I have requested through the Student Accommodation Services. Please check CAPTCHA codeCommentsThis field is for validation purposes and should be left unchanged. Δ
