SDS New Student Registration Request

Student Information

Please enter your information

First Name

Preferred Name

Last Name

Middle Name

Personal Pronouns

Student ID (9 digit Banner ID ex: 004455661)

Please use your university issued email address

Cell Phone

Home Phone

Work Phone

What is the best way to reach you?

Please select if either of the following applies to you:

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?

Undiagnosed, if applicable

How does your disability affect you academically and in your daily life?

Please list any and all previous accommodations issued:

Are you requesting housing accommodations?

Are you a Transfer student (coming from community college or another college/university)?

Do you have any allergies that SDS should be aware of?

Upload supporting document(s)

How did you find out about SDS?

If other, please specify.

If Staff/Advisor, please indicate what department referred you to SDS.

SDS New Student Registration Request

Student Information

Accessibility Specific Information

Document Information