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Online Student Application

Two easy steps to register
Welcome to Accessibility & Disability Services (ADS) at MICA! To register with ADS and request accommodations, students should complete the below form and submit valid documentation. Please be sure to use your MICA email and MICA ID number when completing this application.

Information you provide will be kept private in accordance with the Family Education Rights & Privacy Act (FERPA).The College is bound by The Family Educational Rights and Privacy Act, Amended (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99).
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  7. Hint: Enter 7 alpha numeric characters.
  8. Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Contact Information
  1. Hint: Enter 10-digit number only.
  2. Hint: Enter 10-digit number only.
Local Address
  4. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  2. Secondary Disability(ies)

    Chronic Health Disability

    General Category

    Mental Health Disability

    Neurocognitive Disability

    Physical Disability

    Sensory Disability (Deaf, HOH, Blind, Visual Impairment, etc.)

  4. Affiliation(s)

Questions

  1.  
    Is your disability permanent or temporary? * (Selection is Required)
  2.  
    What is your student status? * (Selection is Required)
  4.  
    Are you requesting disability-related housing accommodations? (If so, please list them below.) * (Selection is Required)
  6.  
    I understand that if I am approved for housing accommodations, ADS will share my approved housing accommodations directly with Residence Life upon approval in order to allow for timely implementation. I also understand that I must reach out to Residence Life directly to ensure proper implementation of any approved housing accommodations. * (Selection is Required)
  8.  
    Did you have an IEP/504 plan in high school? * (Selection is Required)
  9.  
    What type of documentation will you be submitting? * (Selection is Required)
  10.  
    What is your major/intended major? * (Selection is Required)
  11.  
    I understand that under federal law, accommodations at the post-secondary level are granted in order to provide access, rather than to ensure success or meet individual preferences. All accommodation requests are considered on an individualized, case-by-case basis. ADS cannot grant accommodations that pose a fundamental alteration to course/program objectives or place an undue burden on MICA. * (Selection is Required)
I have read and understand MICA’s Student Disability Accommodation Policy

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