Student Access Services Intake Form Intake Form 2026

1. Click ‘Get Form’ to open the Student Access Services Intake Form in the editor.
2. Begin by filling in your personal information. Enter your Name, Preferred Name, Last Name, First Name, Middle Initial, and Student ID. Ensure accuracy as this information is crucial for identification.
3. Provide your Birthdate and Student Email. Select your Gender and Preferred Pronoun by checking the appropriate boxes.
4. In the Disability Information section, indicate if you have a diagnosed or suspected disability. Describe its academic impact and list any related medications.
5. Answer questions regarding ACC Status, including whether you have taken the Accuplacer and if you are registered for classes. Provide anticipated test dates where applicable.
6. Complete the Student Intake Checklist with a Specialist. Discuss documentation received and current accommodations.
7. Sign and date the form at the bottom to authorize Student Access Services to hold your confidential information.

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