Disability Accessibility for Students Intake Form

Disability Services for Students (DSS) Intake Form

Today's Date *

First Name *

Last Name *

CCRI Student ID# *

Cell Phone

CCRI Email Address *

Campus

Have you received academic accommodations in the past? If so, what accommodations have you received?

What are some current barriers to your participation as a student at CCRI? *

When During Business Hours Can You Meet?

Do you prefer a virtual appointment or in person?