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Online Student Application

Two easy steps to register
By entering and submitting the form, I am requesting academic accommodations or other services as an individual with disability; as defined by Federal law. Accommodations and services are provided in accordance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990; as respectively amended.

I also acknowledge that the Family Educational Rights and Privacy Act of 1974 (FERPA) allows Harper College to disclose certain information about me. Access & Disability Services (ADS) staff, as officials of the College, can disclose information without my consent for legitimate educational purposes. ADS staff will attempt to limit the sharing of disability-related information about me when possible, but will share pertinent information on my behalf when it relates to my educational goals and/or accommodations.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Hint: Enter 9 alpha numeric characters.
  3. 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
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Questions
  1. Disability Information (Select all that apply):
  2. Have you applied for financial aid? *
  3. How does your disability affect your reading? *
  4. How does your disability affect your spelling? *
  5. How does your disability affect your writing? *
  6. How does your disability affect your math? *
  7. How does your disability affect your understanding of vocabulary? *
  8. How does your disability affect your memory? *
  9. How does your disability affect your attention/concentration? *
  10. How does your disability affect your study habits? (taking notes, studying for exams, etc.) *
  11. How does your disability affect your time management/organization? *
  12. How does your disability affect your understanding of lectures? *
  13. How does your disability affect your ability to take notes? *
  14. How does your disability affect your self control? *
  15. How does your disability affect your ability to interact with others? *
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