Columbia Basin College Disability Support Services

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Introduction

Type: Current.

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.• Introduction message (It’s seen by students before filling out the application): 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.

Application Information

Start Termrequired field:

Personal Information

First Namerequired field:

Preferred Name:

Middle Name:

Last Namerequired field:

School ID:

Hint: Enter 9 alpha numeric characters.

Birth Daterequired field:

Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2025).

Gender:

Pronoun:

Contact Information

Email Addressrequired field:

Primary Phone Number:Specify country code for Primary Phone NumberSpecify Primary Phone Number

Secondary Phone Number:Specify country code for Secondary Phone NumberSpecify Secondary Phone Number

List of Questions

Question 1: What is your preferred way of being contacted by DSS staff?required field

Primary Phone Number

CBC Email Address

Question 2: Do we have your permission to text to your primary phone number?required field

Yes

Question 3: How did you become aware of C.B.C. Disability Support Services?required field

Counseling and Advising Referral

Instructor Referral

Family Member

Other School Disability Services

C.B.C. Website

Event with a Disability Support Services Table

Other (Additional Comment Required)

Additional Comment:

Question 4: Preferred Name:

Question 5: CBC Student ID Number (hint: It is 9 digits):

Question 6: CBC Email Address:

Question 7: Do you have a documented disability?required field

Yes. (please write your diagnosis and any accommodations you have received in the text box) (Additional Comment Required).

No, but I am interested in being evaluated for a mental health and/or learning disability.

I don't know, but I remember receiving services in K-12 (for ex. small-group instruction, resource room, etc.) (Additional Comment Required).

I don't know, and would like to speak to a specialist.

Additional Comment:

Question 8: Have you ever received disability-related services at CBC?required field

Yes

I don't know

Question 9: Do you require Communication Services for your intake appointment?

ASL Interpreter

CART

Spanish Translator

Question 10: Do you have a vision impairment and need assistance locating the DSS office?

Yes

Question 11: Is there any more information you would like to share with us?

Form Submission

Thank you for submitting your application to Disability Support Services (DSS).

Once we’ve received your disability-related documentation and confirmed that you're enrolled in classes, we will contact you by phone and through your CBC student email to schedule an interactive intake appointment. If you're applying for a future quarter, DSS will reach out approximately one month before the quarter begins. Please make sure your phone number is accurate before submitting, as we may use it to follow up with you.

If you have any questions about the process or what to expect, please contact Disability Support Services by emailing dss@columbiabasin.edu, calling (509) 542-4412 ext. 2252, or visiting us at T-422 on the Pasco campus.

Question?

Disability Support Services
dss@columbiabasin.edu
509.542.4412
2600 N. 20th Ave, T-422. Pasco, WA 99301

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