Application Form

Student Information

Please enter your information

First Name

Last Name

Middle Name

Phone Number

Please enter like this example: 123-456-7890

Are you a veteran?

Are you working with Rehabilitation Services?

Ranger Information

Student ID

Ranger Email ONLY

Did you enter your RANGER email above?

Accessibility Specific Information

Instructions: There is much variability within each accessibility category, and therefore, the type of accommodations needed can vary significantly. Below, you will find descriptions of the various types of disabilities recognized in the United States. Student needs vary according to each individual. Therefore, it is important for the participating student to clarify the particular accommodations she or he requests.

My diagnosed disability falls into the following category

Secondary (other) diagnosed disability(ies):

Please describe your diagnosis(es)/disability(ies):

How does your disability affect you academically (ie: taking tests, studying, etc.)?

Please describe your accommodation request(s).

What accommodations are you requesting?

Does the impairment substantially limit a major life activity as compared to most people in the general population?

Upload supporting document(s) here. If you don’t have documents at this time, complete the form and submit.

Appointment Scheduling

Please select the type of appointment you need

Provide three dates and blocks of times you're available for a 30-minute appointment, EXCLUDING TODAY

Appointments are Monday through Friday, 8:30am – 3:00pm. EXCLUDING 12- 1pm

Possible Date 1:

Block of time you're available on Date 1

Provide a BLOCK of time you’re available vs one specific time.
THIS: 9:30am – 11:30am
NOT THIS: 10:00am

Possible Date 2:

Block of time you're available on Date 2

Provide a BLOCK of time you’re available vs one specific time.
THIS: 9:30am – 11:30am
NOT THIS: 10:00am

Possible Date 3:

Block of time you're available on Date 3

Provide a BLOCK of time you’re available vs one specific time.
THIS: 9:30am – 11:30am
NOT THIS: 10:00am

Application Form

Student Information

Ranger Information

Accessibility Specific Information

Appointment Scheduling

Document Information