Online Student Application

1. Start Term *: Select One 2023 - Spring 2023 - Summer 2023 - Fall 2024 - Spring 2024 - Summer 2024 - Fall 2025 - Spring 2025 - Summer 2025 - Fall 2026 - Spring 2026 - Summer 2026 - Fall 2027 - Spring 2027 - Summer 2027 - Fall 2028 - Spring 2028 - Summer 2028 - Fall 2029 - Spring 2029 - Summer 2029 - Fall 2030 - Spring 2030 - Summer 2030 - Fall 2031 - Spring 2031 - Summer 2031 - Fall 2032 - Spring 2032 - Summer
   Note: Select when you would like to start your services.
2. Expected Graduation Term: Select One 2007 - Fall 2008 - Spring 2008 - Summer 2008 - Fall 2009 - Spring 2009 - Summer 2009 - Fall 2010 - Spring 2010 - Summer 2010 - Fall 2011 - Spring 2011 - Summer 2011 - Fall 2012 - Spring 2012 - Summer 2012 - Fall 2013 - Spring 2013 - Summer 2013 - Fall 2014 - Spring 2014 - Summer 2014 - Fall 2015 - Spring 2015 - Summer 2015 - Fall 2016 - Spring 2016 - Summer 2016 - Fall 2017 - Spring 2017 - Summer 2017 - Fall 2018 - Spring 2018 - Summer 2018 - Fall 2019 - Spring 2019 - Summer 2019 - Fall 2020 - Spring 2020 - Summer 2020 - Fall 2021 - Spring 2021 - Summer 2021 - Fall 2022 - Spring 2022 - Summer 2022 - Fall 2023 - Spring 2023 - Summer 2023 - Fall 2024 - Spring 2024 - Summer 2024 - Fall 2025 - Spring 2025 - Summer 2025 - Fall 2026 - Spring 2026 - Summer 2026 - Fall 2027 - Spring 2027 - Summer 2027 - Fall 2028 - Spring 2028 - Summer 2028 - Fall 2029 - Spring 2029 - Summer 2029 - Fall 2030 - Spring 2030 - Summer 2030 - Fall 2031 - Spring 2031 - Summer 2031 - Fall 2032 - Spring 2032 - Summer
   Note: Select when you plan to graduate.
3. First Name *:
4. Last Name *:
5. Middle Name:
6. Optional: Preferred Name:
7. Student ID:
   Hint: Enter 6 alpha numeric characters.
8. Birth Date:
   Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
9. Gender *: Select One Female Male Not Specified Transgender

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

1. Address *:
2. City *:
3. State *: Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Wyoming International
4. Zipcode *:
   Hint: Enter zipcode as 97331 or 97331-0000.

Same as Local Address

1. Address:
2. City:
3. State: Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Wyoming International
4. Zipcode:
   Hint: Enter zipcode as 97331 or 97331-0000.

1. Primary Disability *: Select One === General Category === Autism Spectrum/Aspergers Other Temporary === Learning Disorder === ADD or ADHD Auditory Processing Disorder Learning Disability - NOS Learning Disability - Reading Learning Disability - Writing Non Verbal Learning Disorder === Physical === Blind Deafness Hard of Hearing Low Vision/Visually Impaired Mobility Orthopedic === Psychological === Anxiety Disorder Depressive Disorder Post Traumatic Stress Disorder === Systemic Illness === Chronic Medical Diabetes Seizure Disorder === TBI === Head Injury
2. Secondary Disability(ies)

   General Category

   Autism Spectrum/Aspergers

   Other

   Temporary

   Learning Disorder

   ADD or ADHD

   Auditory Processing Disorder

   Learning Disability - NOS

   Learning Disability - Reading

   Learning Disability - Writing

   Non Verbal Learning Disorder

   Physical

   Blind

   Deafness

   Hard of Hearing

   Low Vision/Visually Impaired

   Mobility

   Orthopedic

   Psychological

   Anxiety Disorder

   Depressive Disorder

   Post Traumatic Stress Disorder

   Systemic Illness

   Chronic Medical

   Diabetes

   Seizure Disorder

   TBI

   Head Injury
3. Other Disability or Note:
4. Seeking Degree: Select One Graduate Post Baccalaureate Undergraduate
5. Major: Select One Contemplative Counseling Psychology Contemplative Education (low residency) Contemplative Psychology Creative Writing & Literature Creative Writing (low residency) Early Childhood Education Environmental Leadership Environmental Studies Interdisciplinary Studies Master of Divinity Music Peace Studies Performance Religious Studies Religious Studies with Language Somatic Counseling Psychology Theater: Contemporary Performance Traditional Eastern Arts Transpersonal Counseling Psychology Transpersonal Psychology: Ecopsychology (low residency) Undecided Visual Arts Writing & Literature Writing & Poetics

Affiliation(s)

6. Affiliation(s)

   Academic Coaching Program

   Counseling Center

   Distance Education

   Division of Vocational Rehabilitation

   Veterans

   Writing Center

Ethnicity(ies)

7. Ethnicity(ies)

   African-American

   Asian or Pacific Islander

   European-American

   Hispanic

   Multi-Racial

   Native American

   Prefer not to disclose

Campus Location(s)

8. Campus Location(s)

   Arapahoe Campus

   Nalanda Campus

   Paramita Campus
9. Additional Note:

1.  

   Preferred Gender Pronoun: * (Selection is Required)

   She/her/hers

   He/him/his

   They/them/theirs

   Ze/Zir/Zem

   Other (Specify Below)

   Additional Note or Comment
2.  

   Veteran Status: * (Selection is Required)

   Yes

   No

   Additional Note or Comment
3.  

   Department of Vocational Rehabilitation Client?: * (Selection is Required)

   Yes

   No

   Additional Note or Comment
4. How many credits are you registered for currently? * (Required)
5.  

   Current Academic Standing * (Selection is Required)

   First-time First-year

   Freshman

   Sophomore

   Junior

   Senior

   Graduate Student

   Additional Note or Comment
6.  

   Transfer student? * (Selection is Required)

   Yes (if yes please list: previous college and reason(s) for transfer) (Specify Below)

   No

   Additional Note or Comment
7.  

   Snow Lion Resident?: * (Selection is Required)

   Yes

   No

   Additional Note or Comment
8.  

   Participation in any leadership activities/programs and/or student groups on campus: * (Selection is Required)

   Yes (Specify Below)

   No

   Additional Note or Comment
9.  

   Do you receive Federal Financial Aid?: * (Selection is Required)

   Yes

   No

   Additional Note or Comment
10.  

    Any history of Academic Probation? * (Selection is Required)

    Yes (Specify Below)

    No

    Additional Note or Comment
11.  

    Any history of Student Code of Conduct violation? * (Selection is Required)

    Yes (Specify Below)

    No

    Additional Note or Comment
12. How did you find out about this office? Did someone refer you? * (Required)
13. What accommodations are you requesting? * (Required)
14.  

    Have you used accommodations before? * (Selection is Required)

    Yes (Please explain which accommodations you have used and how it has helped you) (Specify Below)

    No

    Additional Note or Comment
15.  

    Which of the following academic areas have you experience difficulty?

    Reading

    Writing

    Spelling

    Math/Science

    Test-taking

    Study skills

    Class/oral presentations

    Foreign language

    Attendance

    Following through with directions

    Memorizing/remembering

    Completing assignments on time/time management

    Organizing your schedule

    Registering for classes

    Seeking academic advisement

    Assignments

    Identifying a major

    Other (Specify Below)

    Additional Note or Comment
16. Write a few sentences describing your academic difficulties in your own words: * (Required)
17. What was your High School or most recent University GPA? * (Required)
18.  

    In which of the following social/vocational areas have you experienced difficulty?

    Making friends on campus

    Talking to peers in and out of class

    Anxiety about different elements of college life

    Talking to faculty

    Making independent decisions

    Perceptions of what others are thinking

    Other (Specify Below)

    Additional Note or Comment
19. Write a few sentences describing your social/vocational difficulties: * (Required)
20.  

    Do you have disability documentation that you have submitted to the Office of Disability Resources? * (Selection is Required)

    Yes

    No (Please explain) (Specify Below)

    Additional Note or Comment