NTC Accessibility Services Application

Step 1 of 2

MM slash DD slash YYYY
Name(Required)
Local or Permanent Address(Required)
Preferred course delivery method(Required)
If you had to categories your disability or disabilities, please check all the boxes that apply:(Required)
Have you used or do you currently use any assistive technology?
In High School, were you enrolled in a Special Education Program?
According tot he Americans with Disabilities Act, a disability is defined to be a physical or mental impairment that substantially limits one or more major life activities. Please indicate, from the following list, which major life activities are substantially limited by your disability.(Required)
If you are working with another agency to help support your education please list them here:
Examples include: Vocational Rehabilitation, Veteran's Affairs, Social Services.
Release of Information:
If you would like Accessibility Services to be able to speak to anyone outside of the NTC community about your records and information with our office, please list them below.
Name
Relationship
Contact Information