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

Online Student Application

Two easy steps to register
Welcome to AIM! Please complete the application below to register for services through the Disability Resource Center (DRC).

Please read and answer all the of the questions to the best of your abilities. Once the application and supporting documentation are completed, your application will be reviewed and contacted by your assigned DRC Counselor to schedule an intake meeting. Please allow up to 7-10 business days for review. Accommodations are not applicable until you schedule and attend the intake meeting.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  7. Hint: Enter 8 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
  2. Affiliation(s)
  3. Ethnicity(ies)
  4. Campus Location(s)

Questions

  1.  
    What is the reason for this meeting? Please check all the apply.
  2.  
    Is this your first semester at Montclair State University? * (Selection is Required)
  3.  
    Are you a visiting student? If yes, which college/university do you attend?
  4.  
    Are you a transfer student? If yes, where are you transferring from and did you receive your Associates Degree?
  10.  
    Are you currently receiving services from government rehabilitation agency? Choose from the following:
  11.  
    Emergency Preparedness: Do you require the use of an elevator? * (Selection is Required)
  12.  
    Emergency Preparedness: Can you go up/down stairs? * (Selection is Required)
  13.  
    Emergency Preparedness: Will you require assistance in an emergency situation? If yes, please explain. * (Selection is Required)
  14.  
    How did you hear about the Disability Resource Center?
Licensed to Accessible Information Management LLC Copyright © 2010-2024 by Haris Gunadi. All rights reserved.