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Affiliation Form

THE COLLEGE OF NEW JERSEY (TCNJ)
DISABILITY SUPPORT SERVICES (DSS)
ROSCOE WEST, 130
EWING, NEW JERSEY 08628
PHONE: (609) 771-3199
FAX (609) 637-5121

DSS AFFILIATION FORM

PLEASE NOTE: As part of the affiliation process, you must submit documentation of disability. This documentation should be reflective of how your disability may impact or intersect with the college experience. This documentation (on letterhead) should be nor more than three (3) years old and be provided by a licensed professional. By completing this form, you are notifying TCNJ that you may be requesting reasonable accommodations on the basis of disability.

 

Name:   Date:  
       
Address:  
       
Cell Phone:   Other Phone:  
       
TCNJ email:   Student ID:  
Identify your disability:

 

Describe any previous accommodations that you may have used:

 

 

What accommodations will you be requesting at TCNJ?

 

Do you have any questions at this time?

 

Upon completion, please return both your affiliation form and documentation to DSS via fax or mail. If you have additional questions or concerns about the process for connecting with DSS at TCNJ, please contact:

Meghan L. Sooy, M.Ed., CRC
Director, Disability Support Services
sooym@tcnj.edu
(609)771-3199

 

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