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Online Student Application

Two easy steps to register
Welcome to Disability Support Services at Western Nevada College. We look forward to meeting you to discuss your accommodation needs.

By submitting this form, I acknowledge that: (1) only I, the student or applicant, have filled out this form; (2) this application will not be processed until pertinent documentation of disability has also been provided; (3) the Disability Support Services office staff will consider the accommodations as requested on this form; (4) I authorize the Disability Support Services staff to consult as part of the review process; (5) accommodations, if rendered, may not be the same as those I received in high school or at another institution, and will not apply retroactively; (6) the accommodation determination process may take up to 14 days.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  7. Hint: Enter your NSHE ID without W.
  8. 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 9998888888 for 999 888 8888).
  2. Hint: Enter 10-digit number only (i.e. enter 9998888888 for 999 888 8888).
Permanent Address
  4. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  5. Affiliation(s)
  6. Ethnicity(ies)
  7. Campus Location(s)
Questions
  1. Please identify any secondary disability(ies)
  2. Did you have an IEP in High School?*
  3. Do you have any health issues that may affect academic success?*
  4. Are you currently taking any medications?*
  5. Are you employed? (If yes, please indicate employer information)*
  6. Please select all that you know how to do:
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