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Disability Accommodation Authorization Form

In order to process your request for a disability accommodation, it may be necessary for Meridian to share, review and communicate with others about information that is subject to and protected by the Family Educational Rights and Privacy Act (“FERPA”); however, Meridian will only do so on a need-to-know basis, i.e., as needed to determine your eligibility for a disability accommodation and to provide you with same if and as indicated by such information. You understand, acknowledge and agree that Meridian may speak with and/or request information concerning your disability (“Disability Information”) from your treating provider(s), who shall, upon being furnished a copy of this form, be permitted to share with and provide to Meridian any such Disability Information, including and related supporting documentation, that may be required or requested by Meridian to assess your request for a disability accommodation. You further understand, acknowledge and agree that this permission granted by you is voluntary and that Meridian cannot consider your request for a disability accommodation without receiving and assessing such Disability Information. You expressly grant Meridian permission to contact any treating provider(s) that have been identified by you in your Disability Accommodations Request Form, so that Meridian may determine your need and eligibility for any disability accommodation that has been requested by you.

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By clicking submit you agree to the terms and conditions of the above stated Authorization