Skip to Main Content Skip to Tabs Skip to Sub-Tab Navigation

Online Student Application

Two easy steps to register
Welcome! We recommend uploading documentation in step 2 of this application, but it is not required to submit your application and may be provided separately.

Because the application may time out, we recommend copying your answers in a Word document before submitting.

After you apply, you will receive an "Application Submitted" confirmation if you have correctly completed all steps.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  3. Hint: Enter 7 alpha numeric characters.
Contact Information
Additional Information
Questions
  1. If you have been diagnosed with one or more disabilities, please indicate the type(s) below. *
  2. Have you ever experienced a life-threatening episode related to your condition (such as an allergic reaction, mental health emergency, or seizure requiring a hospital visit)? *
  3. Does your condition and/or any medication(s) taken compromise your immune system? *
Licensed to Accessible Information Management LLC Copyright © 2010-2021 by Haris Gunadi. All rights reserved.