Access Application - Wellness Services

Start term

Note: Select when you would like to start your services.

Which location do you plan to attend?

Union

Rolla

Expected graduation term

Name*

First

Middle

Last

Preferred name (Optional)

Student ID

Hint: Enter 8 alpha numeric characters.

Birthdate

Gender

Cell phone number

Hint: Enter 10-digit number only (i.e. enter 5417377000 for 541 737 7000).

Email address*

Primary disability*

Major

What assistance can Access Services provide?

I am looking for information - I want to know what my options are

I am seeking accommodations - I need academic adjustments and services to access my learning environment

Other (Specify Below)

Additional note or comment

What type of documentation are you submitting?

Additional note or comment

Have you used accommodations previously?

Additional note or comment

How do you rate your self-advocacy skills?

I am not sure what self-advocacy skills are

I have difficulty advocating for myself

I am comfortable advocating for myself

Comments

Additional note or comment

Type the characters*