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Online Student Application

Two easy steps to register
Welcome to Disability Support Services at Columbia Basin College!

Disability Support Services is dedicated to ensuring equal access and inclusion for all students with either temporary or permanent physical, health, learning, sensory or psychological disabilities. Accommodations may include adaptive equipment, technology, testing, classroom tools and information.

Please complete the form below in it's entirety. This will help us serve you better!

IF YOU DO NOT KNOW HOW TO ANSWER A QUESTION, PLEASE PUT 'N/A.'
IF YOU DO NOT KNOW YOUR DIAGNOSIS, PLEASE SELECT 'OTHER.'

Privacy is our priority, however, faculty and staff may be informed of your need for reasonable accommodations once you qualify for services. Information regarding a student's disability is considered confidential and will not be released without written permission.
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.
Local Address
  4. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  2. Secondary Disability(ies)

    1. Deaf/Hearing

    2. Mobility

    3. Speech/Language

    4. Learning Disability

    5. Blind/Visual

    6. Chronic/Acute Health

    7. Neurological/Nervous System

    8. Psychological/Emotional

    General Category

  4. Affiliation(s)

Questions

  4.  
    Do you have a documented disability? * (Selection is Required)
  5.  
    As a student seeking services:
  6.  
    Have you ever received disability-related services at CBC? * (Selection is Required)
  10.  
    CBC Degree Goal
  11.  
    Do you require Communication Services for your intake appointment?
  12.  
    Do you have a vision impairment and need assistance locating the DSS office? * (Selection is Required)

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