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Online Student Application

Two easy steps to register
This Application for Accommodations is the first step to receiving accommodations at Kirkwood Community College. Please provide accurate contact information in order to receive follow up communication. In the second step of this process, individuals will meet with an Accommodations Access Advocate. You will receive an email once your application has been reviewed and information on how to schedule a time to meet with an Advocate. Accommodations are not in place until you've met with an Advocate. You will be asked to provide supporting documentation of your disability to support your requests. To start your application for accommodations, please answer the questions below the best you can.

Note: This application will time out, and will not save if you navigate away from this page. Please keep this in mind when filling out the application.

This application is for any student who is new to accommodations at Kirkwood. If you have submitted an application before, or receive an error message, please contact our office for your next steps. If you need assistance or have any questions, contact the Accommodation Services office at 319-398-5540.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  7. Hint: Enter 8 alpha numeric characters.
  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)

    ADHD - 1

    Anxiety Disorders - 2

    Autism Spectrum Disorder - 3

    Blindness, Low Vision - 4

    Chronic Health/Physical - 5

    Deafness, Hard of Hearing - 6

    General Category

    Learning Disability - 7

    Mood Disorders - 8

    Personality/Psychotic Disorders - 9

    Temporary Disability - 11

    Traumatic Brain Injury - 10

  6. Affiliation(s)
  7. Ethnicity(ies)
  8. Campus Location(s)

Questions

  1.  
    Are you requesting accommodations for * (Selection is Required)
  4.  
    Were you encouraged or referred to seek accommodations? If yes, by who? * (Selection is Required)
  8.  
    What community agencies are you working with currently? Please select all that apply.
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