Student Intake Form

Are you a client of Louisiana Rehabilitation Services?
The accommodations and services will not be provided until you have turned in approved disability documentation. Send documentation to The documentation guidelines will be provided to the students with disabilities.
If the need arise, would you allow the disability services coordinator to discuss your academic performance with instructors, administrative staff, and/or rehabilitation counselors?
I understand that all information will be kept confidential unless I have specified its release. The name listed below will serve as my digital signature.