Skip to Main Content Skip to Tabs Skip to Sub-Tab Navigation

Online Student Application

Two easy steps to register
Thank you for your interest in the Disability Resource Center! We serve students with both temporary and permanent needs. If you are unable to access any content on this form, please contact John Lee (jlee245@calpoly.edu) for assistance.


* Please use your Cal Poly email address (if available) for improved communication. *
If you are not using a Cal Poly approved E-Mail address, be sure to check your 'junk/spam' folders for missing communication.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  3. Note: Go to your Poly Portal, click on the Personal Info tab. You will see your Poly EMPLID on the right.
  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.
  2. Hint: Enter 10-digit number only.
Preferred 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)
Questions
  1.  
    Current Academic Level * (Selection is Required)
  2.  
    Do you use a mobility device? (e.g. scooter, wheelchair, crutches)? * (Selection is Required)
  3.  
    I am comfortable advocating for my disability-related needs * (Selection is Required)
  4.  
    Do you identify as a non-traditional student? (e.g. first generation college student, low income, BIPOC, 25+, parent) * (Selection is Required)
Under the Voter Registration Act (NVRA) of 1992, DRC is an Agency-Based Registration Site, where students have the opportunity to become registered voters during the application process. There is no obligation to register to vote and the student's decision will have no effect on services offered by DRC.

If you do not check a box you will be considered to have decided not to register to vote at this time.
If you would like help in filling out the voter registration application, we will help you. The decision whether to seek or accept help is yours. You may fill out the application in private.

If you believe that someone has interfered with your right to register or to decline to register to vote, your right to privacy in deciding whether to register or in applying to register to vote, or your right to choose your own political party or other political preference you may file a complaint with:
Secretary of State Elections Division 1500 11th Street Sacramento, CA 95814.
Telephone: (916) 653-6814

Licensed to Accessible Information Management LLC Copyright © 2010-2022 by Haris Gunadi. All rights reserved.