Online Student Application

Welcome to Disability Services! Please fill out this form as you are able. We can gather the rest of the information when we meet with you.

Please note the following:
*All communication from us will be sent to your official SCC email address.
*Appropriate documentation must be received before accommodations can be implemented, but if you need help figuring out what documentation you need, please let us know.
*We approve accommodations based on the information you provide.
*It is your responsibility to notify us if your accommodations are not effective, so we can help you identify any access barriers.

Personal Information

Start Term *:
Note: Select when you would like to start your services.
Primary Campus *:
Note: Please select campus location where you will be enrolled.
Expected Graduation Term:
Note: Select when you plan to graduate.
First Name *:
Last Name *:
Middle Name:
Optional: Preferred Name:
Student ID:
Hint: Enter 8 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Gender *:
Pronouns:

Contact Information

Primary Phone Number:
Hint: Enter 10-digit number only.
Secondary Phone Number:
Hint: Enter 10-digit number only.
Email Address *:

Local Address

Address *:
City *:
State *:
Zipcode *:
Hint: Enter zipcode as 97331 or 97331-0000.

Questions

What accommodations would you like to request at SCC?

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