Request for Disability Support Services

Please use this form to request the disability support services you may need at Western State College of Colorado.

First:

Middle:

Last:

Preferred Name:

Student ID Number:

Street:

City:

State:

Zip Code:

Phone:

Email Address:

Please note: Once activated, your WSC email account will be the address used for correspondance.

What is your enrollment status?

First Time Freshman
New Transfer Student
Continuing Student

First Semester of Enrollment

If not a continuing student

Please describe the disability or disabilities for which you are requesting services

How does your disability affect academic and other activities?

Please list the accommodations, auxiliary aids, and services you are requesting

Documentation of Disability

Students who plan to use disability services must provide current documentation of disability from a qualified professional. The documentation must verify the disability and the need for accommodations, auxiliary aids, and services. Specific documentation guidelines are available upon request. Students should keep a copy of their documentation. Disability Services holds this information for seven years after the student leaves the College, at which time it is destroyed.

Documentation has already been sent
Documentation will be sent

Signature

In order to receive services, students need to complete an intake process with a Disability Services staff member. Students who qualify for services work with the staff to determine appropriate accommodations and services. We encourage you to contact Disability Services at any time if you have questions or concerns you would like to discuss. (Type name as an electronic signature)

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