Registration Form

* indicates a required field

Student Information

Please take a few moments to provide the following information. The information that you share will be kept in your confidential record and will be used to facilitate the accommodation process.

Legal First NameRequired *

Preferred First Name

Last NameRequired *

Middle Name

Personal Pronouns

ISU Student ID Number

If you don't currently have an ISU ID number please leave this field blank.

Birthdate

ISU Email

Please use your university issued email address

Alternate Email

Phone NumberRequired *

Additional contact information or accommodations you may need for communicating with our office

Specific Accommodation Information

Referred to Student Disability Resources by

Academic Success Center
ACCESS
Advisor
Athletics
DSO/Student Assistance
DSO/Student Conduct
High School Staff/Counselor
Instructor
International Students and Scholars
Medical Provider
Orientation
Other
Parent
Self
SSSP/Trio
Student Counseling
Student Health
Vocational Rehabilitation

If "other" please specify

What is your disability(ies)?

Attention Deficit Hyperactivity Disorder Autism Chronic Health Communication Hearing Learning Mobility Other Psychological / Mental Health Temporary Injury & Health Conditions Vision

Please explain how your disability affects, limits, or impacts you as a student.Required *

What types of accommodations or assistance might help for your disability?Required *

Degree of seriousness of the concerns with which you are dealing:Required *

0=no impact, 4=severe impact

Degree of seriousness of the concerns with which you are dealing: 0
Degree of seriousness of the concerns with which you are dealing: 1
Degree of seriousness of the concerns with which you are dealing: 2
Degree of seriousness of the concerns with which you are dealing: 3
Degree of seriousness of the concerns with which you are dealing: 4

Describe your concerns

Upload supporting document(s)

Release of Information to Campus Partners

Disability-related information provided to Student Accessibility Services (SAS) is considered an educational record protected by the Family Educational Rights and Privacy Act (FERPA). FERPA permits SAS to share information about a student’s accommodation eligibility and information necessary to implement approved accommodations with other university school officials who have a legitimate administrative need for such information. School officials may include but are not limited to faculty and instructional staff, residence life staff, academic deans and advisors, police and security, and counseling or health center staff. Legitimate administrative need means the school official needs to review an educational record or receive educational record information in order to fulfill their professional responsibilities. By requesting accommodations, students understand that SAS may discuss and/or exchange verbal and written information regarding accommodations and services with campus partners who have a legitimate administrative reason to be informed.

Document Information

Document TitleRequired *

FileRequired *

Maximum file size: 10240kb

Description