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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.

This form should also be used by pregnant students who wish to request accommodations under the Americans with Disabilities Act (ADA), the Illinois Pregnancy Accommodation Act, Title IX, or other applicable state and federal civil rights laws. All information collected during this process will be maintained and used in accordance with the ADA, including its confidentiality provisions.
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.  
    Are you requesting accommodations for a pregnancy-related disability * (Selection is Required)
  2.  
    Disability Information (Select all that apply):
  3.  
    Have you applied for financial aid? * (Selection is Required)
  4.  
    How does your disability affect your reading? * (Selection is Required)
  5.  
    How does your disability affect your spelling? * (Selection is Required)
  6.  
    How does your disability affect your writing? * (Selection is Required)
  7.  
    How does your disability affect your math? * (Selection is Required)
  8.  
    How does your disability affect your understanding of vocabulary? * (Selection is Required)
  9.  
    How does your disability affect your memory? * (Selection is Required)
  10.  
    How does your disability affect your attention/concentration? * (Selection is Required)
  11.  
    How does your disability affect your study habits? (taking notes, studying for exams, etc.) * (Selection is Required)
  12.  
    How does your disability affect your time management/organization? * (Selection is Required)
  13.  
    How does your disability affect your understanding of lectures? * (Selection is Required)
  14.  
    How does your disability affect your ability to take notes? * (Selection is Required)
  15.  
    How does your disability affect your self control? * (Selection is Required)
  16.  
    How does your disability affect your ability to interact with others? * (Selection is Required)
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