Disability Resource Center Information Request Form

First Name *
Last Name *
Panther ID *
Must be 7 characters. Currently Entered: 0 characters.
Email Address *
Phone Phone - ### - ### ####
FIU Student Status *

FIU Student Status Registered Unregistered
Current Academic Level:

Current Academic Level: Freshman Sophomore Junior Senior Grad/Doc/NonDegree
Preferred Campus:

Preferred Campus: Modesto Madique Campus (MMC) Biscayne Bay Campus (BBC)
Request Information on:

Request Information on: Accommodations Services offered Testing Appointments Other Other
Please allow 3 to 5 business days for your request to be processed