Access Application Start TermSelect OneSpring 2021Summer 2021Fall 2021Spring 2022Summer 2022Fall 2022Spring 2023Summer 2023Fall 2023Note: Select when you would like to start your services.Which Campus Do you Plan to Attend?UnionRollaExpected Graduation TermSelect OneSpring 2021Summer 2021Fall 2021Spring 2022Summer 2022Fall 2022Spring 2023Summer 2023Fall 2023Spring 2024Note: Select when you plan to graduate.First Name(required)Last Name(required)Middle NamePreferred Name (Optional)Student IDHint: Enter 8 alpha numeric characters.BirthdateGenderSelect OneFemaleMaleNot SpecifiedOtherTransgenderCell Phone NumberHint: Enter 10-digit number only (i.e. enter 5417377000 for 541 737 7000).Land Line Phone NumberHint: Enter 10-digit number only (i.e. enter 5417377000 for 541 737 7000).Email Address(required)Primary Disability(required)Select OneAutism Spectrum DisorderDeaf/Hard of HearingADD or ADHDDevelopmental Disorder (ID)Emotional or Behavioral DisabilityOther Emotional/BehavioralOther health ImpairmentOrthopedic ImpairmentDisability Not SpecifiedSpecific Learning DisabilitySpeech/Language ImpairmentTraumatic Brain InjuryVisual ImpairmentSecondary DisabilitiesAutism Spectrum DisorderDeaf/Hard of HearingADD or ADHDEmotional or Behavioral DisabilityDevelopmental Disorder (ID)Other Emotional/BehavioralOther Health ImpairmentOrthopedic ImpairmentDisability Not SpecifiedSpecific Learning DisabilitySpeech/Language ImpairmentTraumatic Brain InjuryVisual ImpairmentMajorWhat assistance can Access Services provide?I am looking for information - I want to know what my options areI am seeking accommodations - I need academic adjustments and services to access my learning environmentOther (Specify Below)Additional Note or CommentWhat type of documentation are you submitting?Doctor's ReportPsychologist's/Psychiatrist's Report Sensory Impairment Report Psychoeducational Evaluation Neuropsychological Evaluation Documentation from another college/universityAdditional Note or CommentHave you used accommodations previously?NoYes - During Grade/Middle/High School through an IEP or 504 planYes - In previous college or university settingYes - Through employmentOtherAdditional Note or CommentHow do you rate your self-advocacy skills?I am not sure what self-advocacy skills areI have difficulty advocating for myself I am comfortable advocating for myself CommentsAdditional Note or CommentBy entering your initial below you acknowledge you have read and understand your rights and responsibilities(required)Type the characters(required)Submit
