Philadelphia University + Thomas Jefferson University

Forms

Disability Accommodations Intake Form

This form must be filled out by all students requesting accommodations at Thomas Jefferson University.  The form should be submitted to Jennifer Fogerty, Assistant Provost for Student Affairs by email Jennifer.Fogerty@jefferson.edu or mail:

Office of Student Affairs
Jennifer Fogerty
130 South Ninth Street
Edison Building, Suite 1120
Philadelphia, PA 19107

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.

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 7 days in advance of the exam. For requests made in less than seven days, submit the form and contact Jennifer.Fogerty@jefferson.edu as soon as possible.

Hours
Mondays - Fridays
8am - 5pm  


Edison Building
Suite 1120
(215) 503-6335
(215) 503-2787

 

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