Online Student Application

Questions

1. Please describe the difficulties you are experiencing.
2.  

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

   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
3. 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.)
4.  

   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)? * (Selection is Required)

   Yes

   No

   Unsure

   Additional Note or Comment
5. 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.
6. What accommodations do you anticipate requesting at Dartmouth? (It's okay if you're unsure.)
7.  

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

   Yes

   No

   Unsure

   Additional Note or Comment
8. 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.