Online Student Application

Questions

1.  

   Are you a new or continuing LC State student? * (Selection is Required)

   Incoming student (first semester at LC State)

   Current student (continuing at LC State)

   Future student (planning to attend LC State). Please list anticipated enrollment semester. (Specify Below)

   Other (Specify Below)

   Additional Note or Comment
2.  

   Have you used accommodations previously? * (Selection is Required)

   Yes - During Grade/Middle/High School through an IEP or 504 plan

   Yes - In a previous College or University setting

   No

   Additional Note or Comment
3. Please describe or provide a brief summary of your disability or medical condition. (Description is Required)
4.  

   Please describe the current functional impact of your disability or medical condition. (Selection is Required)

   In class (lectures, labs, physical activity, web based)

   Assignments (reading, writing, calculating, research, typing)

   Related Activities (clinical placement, practicums, internships, field trips)

   Communication (speaking, listening, sending emails, phone calls)

   Evaluation (tests, papers, oral reports, group projects)

   Time Constraints (timed tests, assignment due dates, deadlines)

   Attendance (class, required out of class activities, residential requirements)

   Campus (mobility, navigation, transportation)

   Residence Halls (room needs, dietary needs, climate control, ESA)

   Other

   Additional Note or Comment
5. What services or accommodations do you believe you need to be successful at LC State? If known, please list.
6.  

   If living in campus housing, are you requesting a housing accommodations due to a disability or medical condition? (Selection is Required) Please describe below:

   Single room

   Private room

   Emotional Support Animal

   Dietary meal plan exemption

   Special furniture

   None/Not Living on Campus

   Other (Specify Below)

   Additional Note or Comment
7. Do you have any additional information you want to share about yourself and/or your disability?
8.  

   How do you intend to submit documentation of your disability or medical condition? * (Selection is Required)

   Email (accessibilityservices@lcsc.edu)

   Fax (208-792-2143)

   In-Person (Drop off at office on Lewiston campus)

   Upload to Application

   I do not currently have documentation, but would like to schedule an informational meeting.

   Additional Note or Comment