CAPS/VEP Record Request Form

Please call CAPS and request a reference number to include on this form.

Today's Date Today's Date / MM / DD YYYY
Name
Panther ID
FIU Email
Date of Birth Date of Birth / MM / DD YYYY
I am requesting (check all that apply):

I am requesting (check all that apply): Letter of attendance Medical Support Letter My testing report Documentation for taking a GRE, Bar Exam, or other standardized test Disability paperwork Financial Aid / Scholarships Letter Communication with a new mental health care provider Response to legal matter Other Other
My phone number is: My phone number is: - ### - ### ####
Times I am available to be contacted are: Times I am available to be contacted are: : HH MM AM/PM
: HH MM AM/PM
: HH MM AM/PM
*This form is not to be used to emergency assistance or to contact CAPS/VEP regarding an urgent matter and it may not be reviewed quickly. If this is an emergency, call 911. If you need immediate assistance from CAPS, call 305-348-2277.