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Access Form

Two easy steps to register
The Access Form is for students that are interested in disability accommodations at Bellevue College, and would like to discuss them. Check out our Getting Started with the DRC page for more information about our accommodations process or contact us!

Email Confirmation: When this form is submitted successfully you will receive an email confirmation at your Bellevue College email address. If you do not receive a confirmation email, please email us to let us know!
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  3. NOTE: Please enter the first name you most commonly use, would like to appear on all correspondence from the DRC, and/or want to be referred to as.
  6. Hint: Enter 9 alpha numeric characters.
  7. 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.
  3. Hint: Please enter your Bellevue College email address (@bellevuecollege.edu)
Local Address
  4. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address

  4. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  2. Secondary Disability(ies)

    General Category

  6. Affiliation(s)
  7. Ethnicity(ies)

Questions

  1.  
    Are you a current client with the Department of Vocational Rehabilitation? If yes, please list your DVR counselor and contact information: * (Selection is Required)
  2.  
    Can we leave you detailed voicemails?
  5.  
    We use self-report of a student's disability as our main source of information to determine accommodations. The following questions will allow us to collect some information about your disability barriers and will serve as self report of your disability. If any of these questions do not make sense to answer or are confusing, please feel free to skip them!
  6.  
    Self-Report: What is your disability or health condition? * (Selection is Required)
  7.  
    Self-Report: How long have you experienced your disability or health condition? * (Selection is Required)
  8.  
    Self-Report: How does your disability or health condition impact you? * (Selection is Required)
  9.  
    Self-Report: What barriers do you experience in your daily life (ex. Cannot walk a long distance, difficulty concentrating on reading material for a long period of time)? * (Selection is Required)
  10.  
    Self-Report: What barriers do you experience in school? If you have not been in school for some time what barriers do you think you might experience? * (Selection is Required)
  11.  
    Self-Report: What accommodations would help you have access to school? * (Selection is Required)
  12.  
    Self-Report: Did you have a 504 or IEP while in school? * (Selection is Required)
  13.  
    Do you need an interpreter? ¿Necesita un intérprete?
  14.  
    If you are not registered to vote where you live now, would you like to register to vote now? * (Selection is Required)
  15.  
    Identity-based questions are asked because we believe that students with disabilities are an integral part of diversity. This information is confidential and will only be used in anonymous data analysis. Let us know if you have any questions!
  16.  
    Optional Information: Sexual and Romantic Orientation
  17.  
    Optional Information: Have you served in the military?
  18.  
    Optional Information: Religion/Spirituality
  19.  
    Optional Information: My annual income is...
  20.  
    Is there anything else you want the DRC to know?
  21.  
    A successful submission of this form will send an automatic email to your Bellevue College (BC) Email address. Please be sure to check your email regarding next steps. * (Selection is Required)
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