Skip to content
Skip to main menu
Skip to secondary menu
Go to homepage
SDS New Student Registration Request
*
indicates a required field
Student Information
Please enter your information
First Name
Required
*
Middle Name
Last Name
Required
*
Preferred Name
Personal Pronouns
Date of Birth
Required
*
January
February
March
April
May
June
July
August
September
October
November
December
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Student ID (9 digit Banner ID ex: 004455661)
Required
*
Email
Required
*
Please use your university issued email address
Cell Phone
Required
*
Home Phone
Work Phone
What is the best way to reach you?
Required
*
Cell
Home
Work
Email
Please select if either of the following applies to you:
I am a student in the Law School
I am a student in the School of Medicine
Accessibility Specific Information
Instructions: Please tell us about your disability and how it impacts you in the academic setting and in your daily life. If you do not have a formal diagnosis, please indicate this in the space below and describe your current challenges. If undiagnosed, please specify your current status below.
Describe your diagnosed disability?
Required
*
Undiagnosed, if applicable
I have not been diagnosed with a disability
My diagnosis is in progress
How does your disability affect you academically and in your daily life?
Required
*
Please list any and all previous accommodations issued:
Required
*
Are you requesting housing accommodations?
Required
*
Are you requesting housing accommodations?
Yes
Are you requesting housing accommodations?
No
Please describe the nature of your housing accommodation request.
Required
*
What is the disability related reason for your housing request?
Required
*
Upload supporting document(s)
Add Item
How did you find out about SDS?
Required
*
If other, please specify.
If Staff/Advisor, please indicate what department referred you to SDS.
Demographic Information
All personal and disability information will be kept confidential and will be used for the following specified purposes: Student demographic data and record keeping, program eligibility, program evaluation, student needs assessment, federal reporting, and other administrative purposes.
Racial Background
Required
*
Select all that apply.
Asian/ Pacific Islander
Black/ African-American
Caucasian/ White
Middle Eastern/North African
Latino/ Latina
Mexican/ Chicano
Native American
I am a U.S. Citizen or permanent resident as defined by U.S. Citizenship and Immigration Services.
I prefer not to answer.
Ethnic Background: Hispanic/Latinx
Required
*
Ethnic Background: Hispanic/Latinx
Yes
Ethnic Background: Hispanic/Latinx
No
Gender Identity
Required
*
Female
Male
Non-binary/Non-conforming
Other
Prefer not to respond.
Are you a first generation student or First Time In Any College (FTIAC) student?
Required
*
Have either of your parents/guardians graduated from a 4-year institution?
Are you a first generation student or First Time In Any College (FTIAC) student?
Yes
Are you a first generation student or First Time In Any College (FTIAC) student?
No
Are you a Transfer student (coming from community college or another college/university)?
Required
*
Are you a Transfer student (coming from community college or another college/university)?
Yes
Are you a Transfer student (coming from community college or another college/university)?
No
Do you receive a Pell Grant?
Required
*
Do you receive a Pell Grant?
Yes
Do you receive a Pell Grant?
No
Do you have any allergies that SDS should be aware of?
Required
*
Please check this box to indicate that all information provided on this form is true and complete to the best of your knowledge.
Required
*
Yes
Document Information
Document Title
File
Required
*
Maximum file size: 10240kb
Description