CAPS and VEP Record Request 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 for emergency assistance or to contact CAPS and 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.