Student Disability Services Information Form

Student Disability Services Information Form

Please fill out the form below for special services accommodation request. Required fields are indicated with a * symbol. Thank you.

* Full Name
Full Address


Financial Sponsor (check all that apply)

Note: if you deny having a disability, Student Disability Services will be unable to assist you. You must list your disability if you require special accommodations.

Do you have professional documentation of your disability?

Will you require special accommodations?

With reasonable accommodations or adjustments, will you be able to receive training as dictated by the State standards and directed by the policies and procedures of the institution?

Are you presently taking any doctor-prescribed medication, due to your disability or otherwise?

Will any of the above medication interfere with your ability to reasonably function?

Blind or Visually Impaired Students: How will you prefer your reading materials?

If you are selecting the CIS program, have you had any computer literacy training