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Online Student Application

Two easy steps to register
Welcome to Disability Services at MSMC. Please complete the form below in it’s entirety. This will help us serve you better!

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 6 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
  5. Affiliation(s)
  6. Ethnicity(ies)

Questions

  1.  
    Who is filling out this application? * (Selection is Required)
  4.  
    How did you hear about disability services? If referred by a specific MSMC employee, please list their name below as well.
  5.  
    Class Status
  7.  
    Status on Campus * (Selection is Required)
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