Disability Services Intake Form - Eastern Shore Community - es vccs 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information in the designated fields, including your name, date of birth, and contact details. Ensure accuracy for effective communication.
3. Indicate your current enrollment status at ESCC and whether you plan to transfer. This helps the institution understand your academic journey.
4. Fill out the employment section if applicable, detailing your job type and hours worked per week.
5. Select your educational goals from the provided options. This section is crucial for tailoring support services to meet your aspirations.
6. In the disability information section, check all relevant boxes that apply to you and provide a description of how your disability impacts your educational progress.
7. Complete the medication section if necessary, listing any medications you are currently taking.
8. Circle any services or accommodations received in high school or college to inform staff of past support needs.
9. Finally, sign and date the form to confirm that you authorize discussions regarding your accommodations with appropriate personnel.

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