New Student Accommodation(s) Request

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The Center for Equal Access Intake

THE COLLEGE OF ST SCHOLASTICA
The Center for Equal Access
1200 Kenwood Ave. Duluth, MN 55811-4199
Email: access@css.edu 

Please complete the form to your best ability

Please use your CSS issued email address

Please include the date of onset (date it started and was diagnosed).

Do you have a family history of this same or a similar condition?
Please rate, from no impact to severe impact, how your disability limits your life activities in the following areas
Concentrating





Memory





Sleeping





Eating





Self-care





Mobility





Writing or Typing





Reading





Managing internal distractions





Managing external distractions





Timely submission of assignments or exams





Attending class regularly and on time





Stress Management





Organization





Hearing





Vision





(stress, work, family/intimate partner problems, illness, homelessness, etc)

Do you take your medication regularly?
Did you participate in an IEP, 504 or Special Education Services in your K-12 education?

Referral

Were you referred to The Center for Equal Access?