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Online Student Application

Two easy steps to register
The Disability Resource Center (DRC) offers a wide range of support services and accommodations for all undergraduate and graduate students with disabilities. Appropriate services are determined and provided based upon the impact of the student's disability and the academic requirements of the appropriate department, college, school or program.

The information you provide on this application is important to us. We will not share your information with any outside parties, including on-campus departments. We take confidentiality very seriously. We abide by and take great pride in protecting your information and upholding the utmost standards of discretion and diplomacy.

Please complete the following application as thoroughly as possible. Applications will be reviewed in the order that they are submitted. Someone from our office will be in contact with you in as timely a manner as possible. If you have any questions, please contact our office at (775) 784-6000. We look forward to meeting with you.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  7. Hint: Enter 10 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.
Local Address
  4. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address

  4. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  3. Affiliation(s)
  4. Ethnicity(ies)

Questions

  1.  
    What are your reasons for coming to see us? (Please check all that apply)
  6.  
    Do any of the following apply for your credit requirements?
  11.  
    How many times do you read something for comprehension? * (Selection is Required)
  12.  
    Outside of Lecture, how much time do you devote to studying in an average week? * (Selection is Required)
  13.  
    Do you have difficulties with attention or concentration during lectures? * (Selection is Required)
  14.  
    Did you attend more than two elementary schools? If yes, please explain. * (Selection is Required)
  15.  
    Did you attend more than three middle or high schools? If yes, please explain. * (Selection is Required)
  16.  
    Were you ever retained in school, or held back to repeat a grade? If yes, please explain. * (Selection is Required)
  17.  
    Have you ever received any special education services (e.g. IEP/504 plan, resource room, speech therapy). * (Selection is Required)
  18.  
    Does anyone in your family have any type of disability (e.g. physical, mental, emotional, substance abuse, learning disability)? If yes, please explain. * (Selection is Required)
  19.  
    While you were growing up, were there any family issues that impacted how you did in school? If yes, please explain. * (Selection is Required)
  21.  
    Have you ever experienced a traumatic brain injury? If yes, please explain. * (Selection is Required)
  22.  
    Have you ever experienced a concussion? If yes, how many, at what age, did you seek treatment? * (Selection is Required)
  23.  
    If yes to the previous question, have you experienced any lasting physical or mental symptoms that you attribute to the incident? * (Selection is Required)
  24.  
    Have you ever had seizures? If yes, please explain. * (Selection is Required)
  25.  
    Have you ever had any serious injuries, illness, or chronic conditions? If yes, please explain. * (Selection is Required)
  26.  
    Are you currently, or have you previously worked with a counselor, therapist, or psychiatrist? If yes, please explain and provide as detailed information as possible (e.g. contact information, appointment timeline, etc.). * (Selection is Required)
  27.  
    Do you have a history of drug and/or alcohol abuse? If yes, please explain. * (Selection is Required)
  28.  
    Are you currently, or have you previously been prescribed any medications related to your disability? If yes, please list any relevant medications. * (Selection is Required)
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