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Online Student Application

Two easy steps to register
Welcome to Ensign Disability Services. Please complete the form below in its entirety.

Please know that the information you provide will be kept private in accordance with the Family Education Rights & Privacy Act (FERPA). For more information on FERPA, please visit: https://www.ensign.edu/family-education-rights-and-privacy-act
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  3. Hint: 7 numbers, including leading zero(s).
  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)

    Blind/Visual

    Chronic/Acute Health

    Deaf/Hearing

    General Category

    Learning Disability

    Neurodevelopmental

    Neurological/Nervous System

    Psychological/Psychiatric

    Speech/Language

  2. Affiliation(s)
  3. Ethnicity(ies)
Questions
  1. Have you been diagnosed with a disability? *
  2. How were you referred to Disability Services?
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