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Student s Signature Phone Student s Z Date of Birth Please return the completed information to the appropriate campus Florida Atlantic University Student Accessibility Services 777 Glades Road SU 133 Boca Raton FL 33431 tel 561. 297. 3880 fax 561. 297. 2184 3200 College Avenue LA 131 Davie FL 33314 tel 954. 236. 1222 fax 954. 236. Is the ESA a prescribed part of treatment for this condition YES NO If yes explain what specific symptoms of the disability will be alleviated by the ESA 11. FAU...
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