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Online Student Application

Two easy steps to register
This application is to be completed by the student.

Welcome to Disability Services at Randolph-Macon College! Please complete the application below in it's entirety. This will help us get to know you and better serve your needs. The information you provide in this application 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.

Questions

  1.  
    Have you been diagnosed with a disability/medical condition? * (Selection is Required)
  4.  
    Have you used academic accommodations in the past? If yes, please describe what accommodations you utilized, which school provided accommodations, and if they were helpful or not in the text box below. * (Selection is Required)
  5.  
    Accommodation Request(s) * (Selection is Required)
  6.  
    Do you have side effects from a medication that impacts you in the educational environment? If yes, please describe these side effects below. * (Selection is Required)
  7.  
    Do you currently utilize any of the services below? (Select all that apply)
  8.  
    Please let us know if you identify with any of the following groups. (Select all that apply)
  9.  
    How did you hear about Disability Services? (Select all that apply)
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