Disability Services Office Intake Form * – indicates a required field. Legal Name* First Last Student Email* Student ID*Phone*Personal Email Semester*Do you have a documented disability?*YesNoDo you have current documentation?*YesNoUpload DocumentsPlease indicate the nature of your disability: (check all that apply)* ADD/ADHD Learning Disability Blind/Low Vision Deaf or Hard of Hearing Speech and Language Impairment (Communication) Psychological (anxiety, depression, mood disorders, etc.) Neurological Medical Disorder Autism/Asperger’s Traumatic Brain Injury Mobility Impairment PTSD Other OtherTypes of requested services (please check all that apply): Extended Time (1.5) Recording Distraction-Free Testing Notetaker Reader/Scribe Assistive Technology Sign Language Interpreter C-Print Other Other types of requested servicesCAPTCHAPhoneThis field is for validation purposes and should be left unchanged.