Accessibility Services registration form

Current and incoming students are welcome to register with Accessibility Services Office (ASO) if they are interested in accessing disability accommodations, exploring eligibility, or just identifying as a student with a disability. We encourage students to register as early as possible, but they are welcome to submit an application at any point during their time at the º£½ÇÉçÇø. To register with ASO and/or request disability accommodations, please complete the fields below.

IMPORTANT: READ BEFORE CONTINUING

This is a legal document and can only be completed by the º£½ÇÉçÇø student themselves; parents/guardians completing this form will result in a deletion of the entire file due to compliance with legal regulations.

Preferred pronouns
Status
12 credits or more
fewer than 12 credits
Are you interested in learning more about any of the additional student support programming at º£½ÇÉçÇø? This may include Educational Opportunity Program (EOP), TRIO Student Support Services (SSS), Advancing Student Academic Success (ASAP), Counseling Services, Community HUB.
Are you served by any of the following supporting agencies?
If you selected any of the agencies above, please list the name of your caseworker/counselor, phone number and name of the agency below.
How did you hear about us and our services?
Semester
Choose the earliest semester for which you are requesting accommodations and will be enrolled in courses.
In your own words, please describe how your disability impacts your daily life both inside and outside the classroom.
This might include things like alternate, distraction reduced test environment, extended test time, note-taking technology and services, text-to-speech software, assistive technology, reduced course load, and more. Noting items does not necessarily guarantee their approval. Final determination will be made by the Accessibility Services Office.
Based on your disability, will you need evacuation assistance or an emergency medical plan?
Under section 504 or the Rehabilitation Act of 1973, a post-secondary student with a disability is required to provide appropriate documentation, which supports a request for academic adjustments or auxiliary aids or the qualifications necessary to participate in academic programs or courses. In recognition of this requirement I give permission to the Accessibility Services Office to verify and request supporting information and documentation of my disability status as necessary. I understand that all documentation is maintained as confidential as outline in the Accessibility Services Handbook. By checking this box, I agree.
I understand the Accessibility Services Office is legally allowed to consult with college faculty or staff who have legitimate educational interest in understanding the functional limitations presented to me by my disability. I understand the sharing of information is limited to the purpose of assisting me to achieve my educational goals and to assure the effective implementation of assigned academic adjustment. I also understand that information related to my disability may be shared in the event of an investigation of a discrimination complaint, medical emergency or potential situations of harm to myself or others. I also recognize that my rights and responsibilities as a student with a disability are detailed in the Accessibility Services Handbook. By checking this box, I agree.
Please upload any supporting documents.
One file only.
1.5 GB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.