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Online Student Application

Welcome to Sinclair Accessibility Services! If you have completed the Student Application but need to make changes to your accommodations, please contact your counselor in the office.

After completing this form, please contact the Accessibility Services (937-512-5113) to set up an intake appointment. Accommodations cannot be addressed until consultation with the assigned counselor.

All documentation of disability is kept private in accordance with the Family Education Rights & Privacy Act (FERPA). For more information on FERPA, please visit: https://www.sinclair.edu/services/welcome-center/registration-and-student-records/student-records/family-education-rights-privacy-act-ferpa/
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  3. Hint: Enter 7 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.
Local Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address

  1. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  1. Secondary Disability(ies)

    ADHD/ADD

    Autism Spectrum Disorders (ASD)

    Learning Disability

    Medical

    Psychological Condition

    Sensory Conditions

    Unknown

  2. Affiliation(s)
  3. Ethnicity(ies)
  4. Campus Location(s)
Questions
  1. Which Status best applies to you?
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