Disability Services Application

  • Note: You will need to have the following documents prepared to upload/attach in order to submit this form:



  • Disclosure Information

    By completing and signing this intake application, you are voluntarily disclosing a disability or disorder and requesting accommodations. Disclosure of your disability at this time does not necessarily confirm your eligibility status for services or accommodations. The verification process may take several weeks or longer, depending upon the appropriateness and currency of the documentation you have submitted.

    In addition, all information submitted to this office is to be completely confidential and used only in connection with this institution's commitment and obligation to students with disabilities. Information may be shared in an emergency situation only.

  • Your Information

  • - Your student ID is 9 digits and begins with 900
  • Disability - Check all that apply:

    (BCC: Disability)
  • Documents

  • Please upload a copy of your detailed schedule. You can retrieve this information from Banner Web (Opens in a new tab/window).
    Accepted file types: txt, doc, docx, rtf, pdf, jpg, png, Max. file size: 25 MB.
  • Accepted file types: txt, doc, docx, rtf, pdf, jpg, png, Max. file size: 25 MB.
  • Accepted file types: jpg, png, pdf, Max. file size: 3 MB.
  • Download, fill out, and save the document: Accommodations - Student Responsibilities Sheet (Opens in a new tab/window). Attach the filled out form here.
    Accepted file types: pdf, Max. file size: 25 MB.
  • Consent

  • (List names permission is given to.)
  • Signature