Skip to Main Content Skip to Tabs Skip to Sub-Tab Navigation

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? * (Selection is Required)
  3.  
    How does your disability affect your reading? * (Selection is Required)
  4.  
    How does your disability affect your spelling? * (Selection is Required)
  5.  
    How does your disability affect your writing? * (Selection is Required)
  6.  
    How does your disability affect your math? * (Selection is Required)
  7.  
    How does your disability affect your understanding of vocabulary? * (Selection is Required)
  8.  
    How does your disability affect your memory? * (Selection is Required)
  9.  
    How does your disability affect your attention/concentration? * (Selection is Required)
  10.  
    How does your disability affect your study habits? (taking notes, studying for exams, etc.) * (Selection is Required)
  11.  
    How does your disability affect your time management/organization? * (Selection is Required)
  12.  
    How does your disability affect your understanding of lectures? * (Selection is Required)
  13.  
    How does your disability affect your ability to take notes? * (Selection is Required)
  14.  
    How does your disability affect your self control? * (Selection is Required)
  15.  
    How does your disability affect your ability to interact with others? * (Selection is Required)
Licensed to Accessible Information Management LLC Copyright © 2010-2022 by Haris Gunadi. All rights reserved.