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Online Student Application

Two easy steps to register
Thank you for your interest in the Learning Assistance Program (LAP) at Allan Hancock College. We are committed to providing equal opportunity and access to students with disabilities through accommodations, academic adjustments, learning disability assessment, counseling, and advocacy.

Please review the LAP Student Rights and Responsibilities.

As you complete the application, please enter something in each textbox. If you do not have information to share, NA is fine.

If you are unable access any content on this online application, contact the LAP office at 805-922-6966 ext. 3274 or
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  3. Hint: Enter 9 alpha numeric characters.
  4. 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.


    Please select any and all of the following diagnoses you identify with. If you do not have a diagnosis, please select one of the last two choices.
    Have you received disability services at another college? If yes, please list your prior college(s). * (Selection is Required)
    What accommodations are you requesting at Allan Hancock College?
    Did you have a 504 plan or IEP in high school?
    Did you receive your high school diploma or GED? * (Selection is Required)
    Do you use assistive technology (i.e. e-text, screen readers, CCTV's)? If yes, please list any assistive technology you use. Such as voice recognition software, screen readers, magnification technology, etc. * (Selection is Required)
    In which of these areas have you had difficulty?
    Do you need help evacuating in case of an emergency? * (Selection is Required)
    Choose the option for where your intake interview appointment will be scheduled. * (Selection is Required)
Important Notices for National Voter Registration

1. Applying to register or declining to register to vote will NOT affect the amount of assistance that you will be provided by the Learning Assistance Program. To register to vote, or to update your voter registration information, please visit .

2. If you would like help in filling out the voter registration form, we will help you. The decision whether to seek or accept help is yours. You may fill out the voter registration form in private.

3. If you believe that someone has interfered with your right to register or to decline to register to vote, your right to privacy in deciding whether to register or in applying to register to vote, or your right to choose your own political party preference or other political preference, you may file a complaint with the Secretary of State by calling toll-free (800) 345-VOTE (8683) or you may write to : Secretary of State, 1500 - 11th Street, Sacramento, CA, 95814. For more information on elections and voting, please visit the following website for the County Elections Division at

The information contained in this application is as accurate as possible. This confidential information may be shared on my behalf with Allan Hancock College's personnel who are directly involved with the Learning Assistance Program (LAP). After completing the intake process with the LAP, my connection to the program will be visible in the Student SuccessNet Platform only to those Allan Hancock College personnel that have a legitimate educational interest related to my support network.

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