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General Information
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Full Name
*
Preferred Name
Pronouns
*
Student ID Number
*
Date of Birth
*
Program of Study
*
Name of High School
*
What semester do you anticipate starting at Kish?
*
Is this your first time attending college?
*
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No
Contact Information
Kishwaukee College Email Address
*
Preferred Phone Number
*
Disability
*
ADD/ADHD
Autism Spectrum
Blind/Low Vision
Chronic Medical Condition
Cognitive/Intellectual
Deaf/Hard of Hearing
Orthopedic
Physical/Mobility
Pregnant/Parenting
Psychological
Specific Learning Disability
Speech or Language
Temporary Disability
Traumatic Brain Injury
Unknown
Other
Check all that apply
If chronic medical condition, psychological, or other, please specify
*
Documentation
Please review the following form before submitting your documentation to help ensure it will be sufficient.
Documentation Form
Upload supporting document(s)
Doctor's letter, IEP, 504 Plan, Disability Testing, etc.
Accommodations
What accommodations have you used in the past?
*
What accommodation(s) are you requesting?
*
What concerns or barriers do you have due to your disability, illness, or temporary condition at Kish?
*
If you anticipate needing an accommodation, such as a sign language interpreter, to fully participate in an intake meeting, please specify below:
Once the intake form is submitted, the Disability Services office will send an email to you to schedule an intake appointment. Please make sure to check your Kish email.
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June 24, 2024 07:22 P.M.