Online Student Application

Personal Information

Start Term *:
Note: Select when you would like to start your services.
Expected Graduation Term:
Note: Select when you plan to graduate.
First Name *:
Last Name *:
Middle Name:
Optional: Preferred Name:
Student ID:
Hint: Enter 7 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Gender *:

Contact Information

Local Address

Permanent Address

Same as Local Address

Additional Information

Are you a new, current, or returning student to Clackamas Community College? * (Selection is Required)

New

Returning after one or more terms away

Current

Additional Note or Comment
Does your diagnosis affect your in person learning environment in the classroom?
Does your diagnosis affect your ability to take notes during lecture?
Does your diagnosis affect your ability to read textbooks, articles, and handout material?
Does your diagnosis affect your ability to participate in the class such as discussions and group work?
Does your diagnosis affect your ability to take a test?
Is there anything you would like the DRC to know before our meeting?
Do you need an American Sign Language Interpreter or CART Services for this meeting? * (Selection is Required) * (Selection is Required)

Yes, I need American Sign Language (ASL)

Yes, I need CART

No, I do not need any.

Additional Note or Comment

Need Help?

Access Tutorials
Contact Our Office
Read Disclaimer

Clackamas Community College
19600 Molalla Avenue
Oregon City, OR 97045

Website: http://www.clackamas.edu/DisabilityResourceCenter/
Email Us: drc@clackamas.edu

Phone: (503) 594 - 6357
Fax: (503) 722 - 5865