Online Student Application

Please describe the difficulties you are experiencing. *

If you have been diagnosed with one or more disabilities, please indicate the type(s) below. *

Asperger's or Autism Spectrum

Attention-Deficit/Hyperactivity Disorder (ADD or ADHD)

Chronic Health Impairment

Deaf and Hard of Hearing

Speech, Language, and/or Learning Disorder

Mobility Impairment/Orthopedic

Psychological Disability

Traumatic Brain Injury

Visual Impairment or Blindness

Other

Undiagnosed

Temporary Condition or Injury (Please see Temporary Conditions before completing this application.)

Additional Note or Comment

What would you like us to know about medication(s) you may take and how they affect you? (It's fine to respond with "not applicable, "nothing," or similar.) *

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)? *

Yes

No

Unsure

Additional Note or Comment

What, if any, accommodations have you used at another college, in high school, or in earlier schooling? Please also include any informal arrangements made by instructors. *

What accommodations do you anticipate requesting at Dartmouth? (It's okay if you're unsure.) *

Does your condition and/or any medication(s) taken compromise your immune system? *

Yes

No

Unsure

Additional Note or Comment

What else would you like us to know about you? For example, you could share a fun fact, a hobby, a talent, and/or something that's important to you. *