Accessibility Services
Proctor Request Form

CONTACT

Name: Ethan Wasserman
Position: Assistant Director, Accessibility and Academic Success
Organization: Office of Academic & Career Success

130 South Ninth Street
Edison Building, 18th Floor
Philadelphia, PA 19107

Contact Number(s):

Forms

Disability Accommodations Intake Form

This form must be filled out by all students requesting accommodations at Thomas Jefferson University. The form can be submitted digitally through Accommodate or by mail:

Office of Academics & Career Success
Ethan Wasserman
130 South Ninth Street
Edison Building, Suite 1810J
Philadelphia, PA 19107

Student Disability Accommodations Intake Form (PDF)

Medical Intake Form

If you do not currently have documentation, or your documentation does not meet the documentation standards, utilize the form above.  You will need to fill out Section I of the form and then pass along to the appropriate medical professional.

Medical Intake Form

Proctor Request Form

Faculty, please complete the following form to request a proctor for an upcoming student exam. The Office of Student Affairs will do everything to honor this request; however, we cannot guarantee a proctor will be available for the requested time. Please submit your request seven (7) days in advance of the exam. For requests made in less than seven days, submit the form and contact James.Dyksen@jefferson.edu as soon as possible.

Proctor Request Form

ESA Medical Intake Form

If you are requesting an emotional support animal (ESA), an appropriate medical professional will need to fill out the form above.

ESA Medical Intake Form
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