Online Student Application

Questions

1.  

   What is your student status?

   High school student taking RCC classes

   Incoming student first year

   Current/continuing RCC student

   Returning after absence of 1 or more years

   Other (Specify Below)

   Additional Note or Comment
2.  

   Are you requesting services from Access and Disability Resources?

   Yes - I am requesting services. (Please respond to all remaining questions and submit any documentation you currently have.)

   Maybe - I would like to explore whether I qualify. (Please respond to the rest of the questions with as much information as you can and using "Note Applicable" where appropriate.)

   No - I am not currently requesting services. (You may respond to all remaining questions with the "Not Applicable" checkbox.)

   Additional Note or Comment
3. In your own words, please describe your disability and its impact on your daily life.
4.  

   How does your disability impact you in an academic setting? * (Selection is Required)

   Not applicable

   Response below

   Additional Note or Comment
5.  

   Have you received accommodations in the past, either at school or at work? * (Selection is Required)

   Yes

   No

   Additional Note or Comment
6. What accommodations do you employ in everyday life to help you manage your disability?
7.  

   Please review the Access Office documentation guidelines at https://web.roguecc.edu/disability-services/documentation and submit appropriate documentation for your disability. Online submission using this site is a secure method. * (Selection is Required)

   I am uploading my disability documentation at this time. (You will be prompted to upload after submitting this form.)

   I will upload my disability documentation later.

   I will fax, mail, email, or hand-deliver my disability documentation to Access and Disability Resources.  (See confirmation email message for contact information.)

   I am not requesting disability accommodations or services right now and understand that disability documentation is not required at this time.

   Additional Note or Comment
8.  

   I authorize Access and Disability Resources at RCC to discuss my documentation with the clinician who authored the documentation if additional information or clarification is required. * (Selection is Required)

   Yes

   No

   Not applicable

   Additional Note or Comment
9.  

   By submitting this form, I certify that the information provided is accurate and that I am the student or prospective student to whom it refers. * (Selection is Required)

   I have requested accommodations and/or access services and understand that Access and Disability Resources will review my request and follow up with me to schedule an initial appointment. I understand I must attend an initial appointment to be eligible for any accommodations or access services.

   I have not requested accommodations or access services but understand that if they are needed in the future, I will contact Access and Disability Resources to discuss next steps.

   I have questions about this application and would like someone to follow up with me. (If checked, a staff member will contact you by email. Alternatively, you may contact the Access Office at AccessOffice@roguecc.edu and 541-956-7337.

   Additional Note or Comment