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Online Student Application

Two easy steps to register
Welcome to the Center for Accessible Resources at Linn-Benton Community College.

Steps for getting started with your developing your accommodation plan

• Fill out this application.

• Provide us with documentation or information that supports your disability. You can upload electronic files or deliver your documentation to the office via mail, fax or in person.

• We will contact you within ten working days after submitting this form.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  3. Hint: Enter 9 alpha numeric characters.
  4. Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Contact Information
  1. Hint: Enter 10-digit number only.
  2. Hint: Enter 10-digit number only.
Local Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  1. Secondary Disability(ies)

    General Category

  2. Affiliation(s)
  3. Ethnicity(ies)
  4. Campus Location(s)

Requesting Accommodations at CFAR

03 Test/Quiz Accommodations
07 Accessible Format
04 Deaf and Hard of Hearing
11 Notetaking Services
05 Physical Access
08 Assistive Technology
02 In Class Assistance
06 Flexibility
01 Classroom Access
Questions
  1. Were you referred by someone? *
  2. Did you graduate from high school? *
  3. Did you complete a GED? *
  4. Have you used accommodations in the past? (mark all that apply)
  5. Have you ever worked with a mental health practitioner? *
  6. Do you have access to documentation for your disability? *
  7. Functional Limitations - I have difficulty or may need assistance with:
  8. How do you rate your self-advocacy skills? *
  9. What will happen next? (Check boxes for understanding)
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