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Online Student Application

Two easy steps to register
Completion of this Disability Support Services Application will allow the DSS office to most effectively plan and implement necessary and reasonable accommodations.

This application should be completed by the student. Students are encouraged to submit application and documentation early in the admission/enrollment process. While DSS will review all requests regardless of submission date, some accommodations and access needs do have priority deadlines (especially related to housing, alt format books, and sign language interpreting). DSS cannot guarantee we can immediately meet requests that are received past those priority dates.

Application may time out after 30 minutes and cannot be saved in progress. Some fields will require an answer; indicate NA if not applicable.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  3. Hint: Enter 9 alpha numeric characters.
  4. 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.
Additional Information
  1. Secondary Disability(ies)

    Attention Deficit Hyperactivity Disorder

    Autism Spectrum Disorder

    Blind/Low Vision

    Brain Injury

    Deaf/Hard-of-Hearing

    General Category

    Learning Disability

    Medical/Chronic Health

    Mental Health

    Orthopedic/Mobility

    Speech

  2. Affiliation(s)
  3. Ethnicity(ies)
Please indicate any accommodations you previously used in high school (including those found on an IEP, Section 504 plan, or health plan), or that were used at a different college or university.

Prior Accommodations

Alternative Testing
Alternative Formats
Deaf and Hard of Hearing
Internal Only
Notetaking Services
General Access
Housing Accommodations
Course Participation
Physical Campus Access
Please indicate the accommodations you are requesting at UM. If you need an accommodation not listed, you will have an opportunity to include it while answering the following questions.

Requesting Accommodations at DSS

Alternative Testing
Alternative Formats
Deaf and Hard of Hearing
Internal Only
Notetaking Services
General Access
Housing Accommodations
Course Participation
Physical Campus Access

Questions

  1.  
    What is your current Montevallo classification? * (Selection is Required)
  2.  
    How did you learn about disability services?
  3.  
    Please indicate the general nature of your disability(ies) or diagnosis (es).
  4.  
    Are you now, or will you be after enrollment, living on campus?
  5.  
    Are you receiving support from the Department of Rehabilitation (Vocational Rehabilitation) Services (from Alabama or another state)? * (Selection is Required)
  6.  
    Military Status
Disclosure to the Disability Support Services office is voluntary and all disability-related information will be handled with respect and privacy. In the questions above, students were given an opportunity to list a person with whom the DSS staff has limited permission to communicate during the DSS registration process. Students may choose to sign a FERPA release if they wish a more comprehensive or ongoing release to be in place. The FERPA form may be found online by visiting the University Registrar's page or searching the University website using the keyword FERPA.

Students agree to the following statement when submitting this application:
"I understand that DSS staff may need to share limited but relevant information regarding my disability or access needs with UM faculty or staff to implement appropriate services/accommodations. Contents of my DSS files may also be released to appropriate University officials in other limited circumstances such as an emergency medical or safety situation or to resolve a complaint. I understand that contents of my file may be released off-campus if required by subpoena, court order, etc."

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