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 Logan Duarte (lduarte@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.
  7. Note: Go to your Poly Portal, click on the Personal Info tab. You will see your Poly EMPLID on the right.
  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.
  2. Hint: Enter 10-digit number only.
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

  5. Affiliation(s)
  6. Ethnicity(ies)
  7. Campus Location(s)
Questions
  1. Student Entry Status *
  3. Please select any and all of the following diagnoses that you identify with:
  5. Do you have limitations in any of the following areas? Select all that apply:
  7. Do you use a mobility device? (e.g. scooter, wheelchair)? *
  9. Do you currently have a service animal? *
  12. The following questions will help us understand how to best assist you. A few of the questions pertain to "accommodations." Accommodations are resources, tools, or strategies that minimize the impact of disability symptoms (e.g. Notetaking assistance): First Question - I am independent in managing my disability related needs *
  13. I am knowledgeable about my rights and successfully advocate for my accommodations: *
  14. I am confident in my ability to use my strengths and seek additional assistance for my weaknesses: *
  15. I successfully communicate my disability related accommodations to others without feeling I have to disclose personal or private information: *
  16. I recognize my right to approved accommodations, whether or not I choose to use them: *
  17. I use the appropriate process to request accommodations and schedule appointments with the DRC: *
Licensed to Accessible Information Management LLC Copyright © 2010-2021 by Haris Gunadi. All rights reserved.