Main Form

Please provide the following contact information:

Student's Name
Date of Birth
Campus ID/Social Security Number
Relationship of person in need of accommodations  ? 
If Student: will someone be accompanying the student?   Yes
No
Parent's name for students under 18 years old
 Name of person needing accommodations
Address
City, State Zip 
Home Phone
FAX
E-mail

Identify the Orientation session you will be attending.

Freshman Orientation

I – June 12-13
II - June 19-20
III - June 26-27
IV - July 17-18
V - July 24-25

Transfer Orientation

VI - May 2
VII - July 11
VIII - August 1

Semester Orientations

Spring: January 10
Summer I - May 29
Summer II - July 7

Select the appropriate accommodations:

Housing
Mobility Assistance
Scribe/Reader
Interpreter

Large Print Format
Braille Format
Tape Format

Describe the type of assistance that you will need during Orientation (Please be specific)


Day(s) assistance is required:

Thursday    
Friday   
Other 

Please print a copy of this form for your records from your navigation bar.  Following Submitting this form you will get an automated web notice confirming your contact information only.  Again, to maintain more CONFIDENTIALITY  than the standard web and e-mail offers fill in the blanks and mail or FAX the form to the address below.

Privacy and Security Policy