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Online Student Application

Two easy steps to register
Welcome to the Educational Access Services New Student Application form!

  • Please note the system will time out after a prolonged period, please be sure to complete this form in one sitting.
  • The process to register with EAS involves completing this application, providing available supporting documentation and completing an Access meeting interview with EAS. Accommodations are not provided until this process is complete and an initial Access meeting has occurred.
  • Please expect an email communication from eas@coloradomesa.edu within 2 business days of submitting this application. We will contact you to set up a time to conduct your initial Access Meeting which can be conducted via online or in person. If you do not hear from EAS after 3 business days please reach out via email or phone.
  • Cancellation - If EAS does not hear from you after our initial communication, we will attempt to contact you via your Mavs email or phone for up to one month after your application submission date. After attempting to contact you at least 3 times without success EAS will cancel your application.
  • All information submitted to EAS will be maintained and used in accordance with applicable confidentiality requirements.
  • Colorado Mesa University may require documentation to substantiate the request for accommodations
  • Documentation Guidelines are available on the EAS webpage
  • If you need assistance completing this online form or would like to talk with EAS staff prior to submitting a request, please contact via eas@coloradomesa.edu or phone 970-248-1856.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  7. Hint: Enter 9 alpha numeric characters.
  8. 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
  4. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address
  4. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  2. Secondary Disability(ies)

    Attention

    Deaf/Hard of Hearing

    General Category

    Learning Disability

    Physical/Mobility

    Psychological/Emotional

    Vision

  5. Affiliation(s)
  6. Ethnicity(ies)
  7. Campus Location(s)

Requesting Accommodations at EAS

CMU/CU Boulder Engineering Partnership Program

Questions

  4.  
    Please select the type of documentation you have:
  5.  
    How were you referred to Educational Access Services? Please list the name if it was a staff member on campus. * (Selection is Required)
  6.  
    Do you have any additional information you would like to share that you feel will help EAS better understand how your disability impacts your education? * (Selection is Required)
By submitting this form, I agree to the following terms and conditions:

I understand that all information maintained by the Educational Access Services department is part of my educational record and as such is protected by the Federal Family Educational Rights and Privacy Act (FERPA of 1974). I understand that my educational records cannot be released or discussed without my written permission except for certain circumstances as permitted under FERPA:

  • When the student requests that information be released to a third party.
  • In extreme situations where immediate harm to self or others may result, the law requires the essential information be reported to the appropriate parties.
  • When required by a court order.
  • We may discuss the implementation of accommodations with CMU staff and faculty who have a legitimate need to know, including the Student of Concern Team. This includes sending accommodation notifications to the students’ instructors.

I will complete the Information Release Consent form on my AIM portal dashboard and add any individual/agencies that I authorize EAS to share information with from my records.

Please use the following function if you need more than 15 minutes to complete the application. A maximum of 60 minutes before the session is removed.

Session Extender

Status: off
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