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Online Student Application

Two easy steps to register
Welcome to the Accessibility Services Center (ASC) Online Student Accommodation Profile Request Form.

Please complete this form in its entirety, as it will allow us to have the most complete information when making accommodation decisions.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  7. Hint: Enter 9 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.
  3. Hint: Only @stetson.edu will be accepted
Local Address
  4. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  2. Secondary Disability(ies)

    ADHD

    Allergic Disorders

    Autism Spectrum Disorder (ASD)

    Autoimmune Disorder

    General Category

    Genetic Disorder

    Health Impairment (OHI)

    Mental Health/Psychological Disorder

    Motor Impairment

    Neurocognitive Disorder

    Neurologic Disorder

    Physical/Mobility

    Respiratory Illness

    Sensory Impairment

    Specific Learning Disability (SLD)/LD-NOS

    Temporary

    Vascular Disorder

  4. Affiliation(s)
  5. Campus Location(s)

Questions

  1.  
    What is your disability/ies (please check all that apply)
  2.  
    Is this a short-term or temporary disability/impairment? * (Selection is Required)
  6.  
    What type of accommodations are you requesting?
  9.  
    Who referred you to the Accessibility Services Center (ASC)?

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