Forms

Power-Based Violence/Title IX Forms

Power-Based Violence/Title IX Report (PDF)

This form is used to submit reports of power-based violence and Title IX misconduct.

Power-Based Violence Victims' Rights Policy Petition

This form is used by a victim to petition the Title IX Coordinator to have a perpetrator of an incident of power-based violence against the victim barred from attending a class in which the victim is enrolled.

Power-Based Violence/Title IX Notice of Appeal

This form is used to appeal the dismissals, written findings, and any sanctions, if applicable, of a matter adjudicated through the power-based violence grievance or the Title IX Formal Grievance Procedure.

Power-Based Violence Victims' Rights Policy Petition Appeal

This form is used to appeal the decision of the Title IX Coordinator regarding a Victims' Rights Policy petition.

Power-Based Violence Transcript Withholding and Notation Appeal

This form is used to appeal transcript withholding and notation.

Confidential Advisor Attestation Form

This form is used by confidential adivsors to attest to their training completions.

Americans with Disabilities Act Forms

ADA Complaint Form (PDF)

This form is for ADA compliants.

Request for ADA/Workplace Accommodation Form (PDF)

This form is for accommodation requests for the general public, employees, and job applicants. Academic accommodations for students are made using the Application for Student Accommodations through the Disability Services Coordinator.

Supervisors to Provide Nofification of an Employee's ADA Accommodation Request

This form is for supervisor's to notify the ADA coordinator of an employee's ADA accommodation request.

Workplace Accommodation Appeal

This form is for appeals of workplace accommodations.

Medical Inquiry Form

Workplace Accommodation Telework Agreement Form

Disability Services Forms

(Forms for Student Academic Accommodations)

Application for Student Accommodations (PDF)

This form is for student's to apply for academic accommodations. 

Disability Services Formal Grievance Form (PDF)

This form is for formal grievances by students for disability discrimination under the Disability Services Policy. This includes disagreements regarding a requested service, accommodation, auxiliary aid, or modification of a System practice or requirement; denial of a request; inaccessibility of a program or activity; or a violation of privacy in the context of a disability.

Disability Verification Form

Housing Forms for Service and Emotional Support Animals

Service or Emotional Support Animal Registration Form

Veterinarian Verification Form

Roommate Acknowledgement Form

Ethics Forms

Complimentary Admission, Lodging and/or Transportation Disclosure Statement

This website uses cookies to ensure site visitors get the best experience on our website. By continuing to use this site, you accept our use of cookies and Privacy Statement. To find out more, please visit Southern University's Privacy Statement.