Self Disclosure Intake Form

If you have any questions please reach out to your appropriate campus contact for any questions. Campus contacts are listed at this website: https://ctstate.edu/odas/campus-contacts
* indicates a required field

Welcome!

The Self-Disclosure Intake Form should only be filled out after you have been accepted to the CT State Community College system and provided an official CT State Student/Banner ID.

If you are looking for additional information about our services prior to enrolling, please reach out to your appropriate campus ODAS office. You can find the contact information here:  https://ctstate.edu/odas/campus-contacts

If you have not yet applied to the CT State Community College system, you can do so here: https://ctstate.edu/admissions-registration/how-to-apply

Student Information

Please fill out the following
Please write your first name as it appears on your College ID.
Please write your last name as it appears on your College ID.

Do not include @ sign. Please enter your 8-digit student ID number (e.g. 01234567). 

Please use your email ending in '@mail.ct.edu' or '@ctstate.edu'.

Please note that Disability Services will contact you through your CT State Community College email address, ending with @mail.ct.edu for scheduling. 
Preferred Pronoun
Have you been approved for accommodations by one of the CT State Community College legacy campuses before? Required

If YES to prior approved accommodations at a legacy campus, select the campus where accommodations were previously approved.

If NO to prior approved accommodations, select the campus from which you plan to graduate from or take most of your coursework.

Academic Information

Disability and Accommodation Self-Report

Please understand that this does not guarantee specific accommodations will be approved.
Please understand that this does not guarantee specific accommodations will be approved.
How did you hear about the Office of Disability Services?
Documentation

Documentation Guidelines 

AgreementRequired

The Office of Disability Services will review your request as soon as possible. We will contact you by through your CT State Community College email to schedule an intake interview for our interactive process. Please understand that submitting your request does not guarantee academic accommodations. 

Agreement to initiate full process Required