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Online Student Application

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

If you have previously submitted an application, DO NOT submit a new one. Please email disability.services@life.edu for assistance.

Please know that the information you provide will be kept private in accordance with the Family Education Rights & Privacy Act (FERPA).
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  7. Hint: Enter 7 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.
  3. Hint: If you are a current student at Life, please enter your @student.life.edu email address.
Local Address
  4. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address
  4. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  3. Affiliation(s)
  4. Ethnicity(ies)

Questions

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