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Online Student Application
Online Student Application
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Please read before completing application:
You should have already applied and been admitted to Texas A&M University-Corpus Christi (TAMU-CC). If you have not done so, but would like to receive more information about our services, please contact our office at 361-825-5816 or
disability.services@tamucc.edu
.
During the application process, you will need to submit documentation of your disability. For specific information regarding acceptable documentation, please see (
http://disabilityservices.tamucc.edu/services/index.html#Documentation
). You will be given the opportunity to upload your documentation after completing this form (please be advised that the file size cannot exceed 1MB). If you do not have your documentation available, you may still submit the application today and upload your documentation at a later date (a direct link to upload documentation will be provided to you in the confirmation email that your application has been received).
After your application and documentation have been received, please allow up to seven business days for our staff to review your file and contact you regarding next steps, which will include an Access Planning Meeting to determine appropriate academic accommodations, if documentation is sufficient.
If you have any questions or concerns regarding the application process or our services in general, please contact us:
In person: Corpus Christi Hall 116
By phone: 361-825-5816
Via email:
disability.services@tamucc.edu
Please note that all "Questions" must be answered on the form before submitting.
Personal Information
Start Term
*
:
Select One
2022 - Summer
2022 - Fall
2023 - Spring
2023 - Summer
2023 - Fall
2024 - Spring
2024 - Summer
2024 - Fall
2025 - Spring
2025 - Summer
2025 - Fall
2026 - Spring
2026 - Summer
2026 - Fall
2027 - Spring
2027 - Summer
2027 - Fall
2028 - Spring
2028 - Summer
2028 - Fall
2029 - Spring
2029 - Summer
2029 - Fall
2030 - Spring
2030 - Summer
2030 - Fall
2031 - Spring
2031 - Summer
2031 - Fall
2032 - Spring
2032 - Summer
2032 - Fall
2033 - Spring
2033 - Summer
2033 - Fall
2034 - Spring
2034 - Summer
2034 - Fall
2035 - Spring
2035 - Summer
2035 - Fall
Note: Select when you would like to start your services.
Expected Graduation Term:
Select One
2011 - Spring
2011 - Summer
2011 - Fall
2012 - Spring
2012 - Summer
2012 - Fall
2013 - Spring
2013 - Summer
2013 - Fall
2014 - Spring
2014 - Summer
2014 - Fall
2015 - Spring
2015 - Summer
2015 - Fall
2016 - Spring
2016 - Summer
2016 - Fall
2017 - Spring
2017 - Summer
2017 - Fall
2018 - Spring
2018 - Summer
2018 - Fall
2019 - Spring
2019 - Summer
2019 - Fall
2020 - Spring
2020 - Summer
2020 - Fall
2021 - Spring
2021 - Summer
2021 - Fall
2022 - Spring
2022 - Summer
2022 - Fall
2023 - Spring
2023 - Summer
2023 - Fall
2024 - Spring
2024 - Summer
2024 - Fall
2025 - Spring
2025 - Summer
2025 - Fall
2026 - Spring
2026 - Summer
2026 - Fall
2027 - Spring
2027 - Summer
2027 - Fall
2028 - Spring
2028 - Summer
2028 - Fall
2029 - Spring
2029 - Summer
2029 - Fall
2030 - Spring
2030 - Summer
2030 - Fall
2031 - Spring
2031 - Summer
2031 - Fall
2032 - Spring
2032 - Summer
2032 - Fall
2033 - Spring
2033 - Summer
2033 - Fall
2034 - Spring
2034 - Summer
2034 - Fall
2035 - Spring
2035 - Summer
2035 - Fall
Note: Select when you plan to graduate.
First Name
*
:
Last Name
*
:
Middle Name:
Optional: Preferred Name:
Student ID:
Hint: Enter 9 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Gender
*
:
Select One
Female
Male
Not Specified
Contact Information
Primary Phone Number:
Hint: Enter 10-digit number only.
Secondary Phone Number:
Hint: Enter 10-digit number only.
Email Address
*
:
Local Address
Address
*
:
City
*
:
State
*
:
Select One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Wyoming
International
Zipcode
*
:
Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address
Same as Local Address
Address:
City:
State:
Select One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Wyoming
International
Zipcode:
Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
Primary Disability
*
:
Select One
=== General Category ===
ADD or ADHD
Autism Spectrum
Blind/Visually Impaired
Chronic Medical
Deafness or Hearing Loss
Head Injury
Learning Disability
Mental Health
Mobility
Orthopedic
Other
Speech
Temporary
Secondary Disability(ies)
General Category
ADD or ADHD
Autism Spectrum
Blind/Visually Impaired
Chronic Medical
Deafness or Hearing Loss
Head Injury
Learning Disability
Mental Health
Mobility
Orthopedic
Other
Speech
Temporary
Other Disability or Note:
Seeking Degree:
Select One
Doctoral Degree
Master's Degree
Post Baccalaureate
Undergraduate
Major:
Select One
Accounting
Applied Arts & Sciences
Art
Art, Studio
Athletic Training
Biology
Biomedical Sciences
Business (MBA)
Business, General
Chemistry
Clinical Laboratory Science
Coastal and Marine System Science
Communication
Computer Science
Counseling
Counselor Education
Criminal Justice
Curriculum and Instruction
Early Childhood Instruction
Economics
Educational Administration
Educational Leadership
Educational Technology
Electrical Engineering Technology
Elementary Education
English
Environmental Science
Finance
Fisheries and Mariculture
Geographic Information Science
Geographic Information Systems
Geology
Geomatics
Geospatial Surveying Engineering
Health Care Administration
Health Sciences
History
Homeland Security
Interdisciplinary Studies (Teacher Education)
Kinesiology
Management
Management Information Systems
Marine Biology
Marketing
Mathematics
Mechanical Engineering
Mechanical Engineering Technology
Music
Nursing
Occupational Training and Development
Philosophy
Political Science
Pre-dental
Pre-law
Pre-medical
pre-optometry
pre-veterinary medicine
Psychology
Public Administration
Reading
Secondary Education
Sociology
Spanish
Special Education
Theatre
Affiliation(s)
Affiliation(s)
Behavioral Health Center of Nueces County or local community mental health center
CAMI Project 31 Research Participant
DARS-Division for Blind Services (DBS)
Deaf and Hard of Hearing Center
Department of Assistive and Rehabilitation Services (State Vocational Rehab Services)
U.S. Department of Veterans Affairs
Ethnicity(ies)
Ethnicity(ies)
African-American
Asian or Pacific Islander
European-American
Hispanic
Multi-Racial
Native American
Campus Location(s)
Campus Location(s)
Online only
TAMUCC Campus
Additional Note:
Questions
What is your classification?
Freshman (1-29 credit hours)
Sophomore (30-59 credit hours)
Junior (60-89 credit hours)
Senior (90+ credit hours)
Post-Baccalaureate
Graduate (Master’s)
Graduate (Doctoral)
Additional Note or Comment
Are you a transfer student?
*
(Selection is Required)
Yes. What college(s)/university(-ies) did you attend? (Specify Below)
No
Additional Note or Comment
First semester enrolled at TAMU-CC (e.g., Fall 2015)
*
(Required)
Current GPA
*
(Required)
Are you currently on academic probation? (Note: accommodations are not contingent on academic standing)
*
(Selection is Required)
Yes
No. If you have been placed on academic probation or suspension in the past, provide details.
Additional Note or Comment
Are you currently affiliated with any of the following campus offices or programs?
Athletics
Center for Academic and Student Achievement (CASA)
Transition Center
Trio Programs (Student Support Services/STEM/SOAR/TEACH/McNair Scholars)
University Counseling Center
University Health Center
Veterans Affairs
Writing Center
Additional Note or Comment
When was your disability(-ies) diagnosed?
*
(Required)
Please describe your disability and how it has helped or hindered your academic progress and your daily living activities to date.
*
(Required)
Please describe any services (e.g., Special Education/504 or informal accommodation) that you received while in K-12.
*
(Required)
Please describe any services that you received at other college(s)/university(-ies).
*
(Required)
What accommodations/services are you seeking at this time?
*
(Required)
If you are requesting Assistive Technology (e.g., text to speech software, audio books, assistive listening device, screen magnification, etc.), what Assistive Technology have you used in the past?
*
(Required)
Please describe any additional concerns you have or would like to discuss with the Disability Services staff.
*
(Required)
Who referred you to our office?
*
(Required)
Emergency Contact (Name, Relationship, Contact number)
*
(Required)
Acknowledgement
I certify that all information I have provided is true and accurate to the best of my knowledge. I understand that intentionally providing false or misleading information may result in my being ineligible for services and may also result in disciplinary action by the Office of Judicial Affairs.
Additional Note or Comment
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