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Online Student Application

Two easy steps to register
Hello Students! Please fill out the following application to register for services for the UCA Disability Resource Center.

Don't forget to call our office at 501-450-3613 to make an appointment as soon as you complete your application.


*Please note: When entering in your UCA ID#, ensure it is 9 digits and begins with a "B". Replace the first "0" with a "B".
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 (i.e. enter 5417377000 for 541 737 7000).
  2. Hint: Enter 10-digit number only (i.e. enter 5417377000 for 541 737 7000).
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)
Please select services you are SEEKING to request with our office, and provide documentation for your eligibility

Requesting Accommodations at DRC

Alternative Testing
Alternative Formats
Deaf and Hard of Hearing
Others
Notetaking Services
Facility/Classroom Access
Questions
  1. Classification:
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