Skip to Main Content
Skip to Tabs
Skip to Sub-Tab Navigation
Sign In
Page Tabs
Home
You are here:
Home
Online Student Application
Online Student Application
Page Options
In order to be connected with the Disability Resource Center (DRC) and to receive accommodations students will first need to complete and submit the registration form below.
TMCC is committed to keeping sensitive disability-related information confidential, and information is only released on a need-to-know basis unless a student specifically gives us permission to share information with specific individuals or entities. The only exception to this policy is set forth in law and regulation, allowing records to be inspected by regulatory, enforcement or evaluative bodies and to be released as ordered by a court.
Please review the
Student Rights and Responsibilites
and the
High School Transition Guide
before submitting this registration form. By submitting this form, you are acknowledging that you have received notice of your rights and responsibilities.
Personal Information
First Name
*
:
Last Name
*
:
Middle Name:
Optional: Preferred Name:
Student ID:
Hint: Enter 10 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Gender
*
:
Select One
Female
Male
Not Specified
Start Term
*
:
Select One
2023 - Fall
2024 - Spring
2024 - Summer
2024 - Fall
2025 - Spring
2025 - Summer
2025 - Fall
2026 - Spring
2026 - Summer
2026 - Fall
2027 - Spring
2027 - Summer
2027 - Fall
2028 - Spring
2028 - Summer
2028 - Fall
2029 - Spring
2029 - Summer
2029 - Fall
2030 - Spring
2030 - Summer
2030 - Fall
2031 - Spring
2031 - Summer
2031 - Fall
2032 - Spring
2032 - Summer
2032 - Fall
2033 - Spring
2033 - Summer
2033 - Fall
2034 - Spring
2034 - Summer
2034 - Fall
2035 - Spring
2035 - Summer
2035 - Fall
2036 - Spring
2036 - Summer
2036 - Fall
2037 - Spring
2037 - Summer
2037 - Fall
2038 - Spring
2038 - Summer
2038 - Fall
2039 - Spring
2039 - Summer
2039 - Fall
2040 - Spring
2040 - Summer
2040 - Fall
2041 - Spring
2041 - Summer
2041 - Fall
2042 - Spring
2042 - Summer
2042 - Fall
2043 - Spring
2043 - Summer
2043 - Fall
2044 - Spring
2044 - Summer
2044 - Fall
2045 - Spring
2045 - Summer
2045 - Fall
2046 - Spring
2046 - Summer
2046 - Fall
2047 - Spring
2047 - Summer
2047 - Fall
2048 - Spring
2048 - Summer
2048 - Fall
2049 - Spring
2049 - Summer
2049 - Fall
2050 - Spring
2050 - Summer
2050 - Fall
Note: Select when you would like to start your services.
Expected Graduation Term:
Select One
2010 - Spring
2010 - Summer
2010 - Fall
2011 - Spring
2011 - Summer
2011 - Fall
2012 - Spring
2012 - Summer
2012 - Fall
2013 - Spring
2013 - Summer
2013 - Fall
2014 - Spring
2014 - Summer
2014 - Fall
2015 - Spring
2015 - Summer
2015 - Fall
2016 - Spring
2016 - Summer
2016 - Fall
2017 - Spring
2017 - Summer
2017 - Fall
2018 - Spring
2018 - Summer
2018 - Fall
2019 - Spring
2019 - Summer
2019 - Fall
2020 - Spring
2020 - Summer
2020 - Fall
2021 - Spring
2021 - Summer
2021 - Fall
2022 - Spring
2022 - Summer
2022 - Fall
2023 - Spring
2023 - Summer
2023 - Fall
2024 - Spring
2024 - Summer
2024 - Fall
2025 - Spring
2025 - Summer
2025 - Fall
2026 - Spring
2026 - Summer
2026 - Fall
2027 - Spring
2027 - Summer
2027 - Fall
2028 - Spring
2028 - Summer
2028 - Fall
2029 - Spring
2029 - Summer
2029 - Fall
2030 - Spring
2030 - Summer
2030 - Fall
2031 - Spring
2031 - Summer
2031 - Fall
2032 - Spring
2032 - Summer
2032 - Fall
2033 - Spring
2033 - Summer
2033 - Fall
2034 - Spring
2034 - Summer
2034 - Fall
2035 - Spring
2035 - Summer
2035 - Fall
2036 - Spring
2036 - Summer
2036 - Fall
2037 - Spring
2037 - Summer
2037 - Fall
2038 - Spring
2038 - Summer
2038 - Fall
2039 - Spring
2039 - Summer
2039 - Fall
2040 - Spring
2040 - Summer
2040 - Fall
2041 - Spring
2041 - Summer
2041 - Fall
2042 - Spring
2042 - Summer
2042 - Fall
2043 - Spring
2043 - Summer
2043 - Fall
2044 - Spring
2044 - Summer
2044 - Fall
2045 - Spring
2045 - Summer
2045 - Fall
2046 - Spring
2046 - Summer
2046 - Fall
2047 - Spring
2047 - Summer
2047 - Fall
2048 - Spring
2048 - Summer
2048 - Fall
2049 - Spring
2049 - Summer
2049 - Fall
2050 - Spring
2050 - Summer
2050 - Fall
Note: Select when you plan to graduate.
Contact Information
Primary Phone Number:
Hint: Enter 10-digit number only.
Secondary Phone Number:
Hint: Enter 10-digit number only.
Email Address
*
:
Please note that we will send all email correspondence to your school email address whenever possible. (your_name@mail.tmcc.edu).
Local Address
Address
*
:
City
*
:
State
*
:
Select One
Select One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Wyoming
International
Zipcode
*
:
Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address
Same as Local Address
Address:
City:
State:
Select One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Wyoming
International
Zipcode:
Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
Affiliation(s)
Affiliation(s)
Nevada Federation for the Blind
Veteran
Vocational Rehabilitation/DETR
Ethnicity(ies)
Ethnicity(ies)
Asian
Asian Indian
Black or African-American
Hispanic or Latino
Native American or American Indian
Pacific Islander or Native Hawaiian
White or Caucasian
Questions
How has your disability made success in school difficult to achieve? Please describe.
*
(Required)
What accommodations have you received in the past? At what institution?
*
(Required)
What assistive technology devices have you been trained to use? (text to speech software, smartpens, etc.)
*
(Required)
Would you like to be assessed for areas where technology may be used to help you overcome challenges related to your disability?
*
(Selection is Required)
Yes
No
Additional Note or Comment
What accommodations are you interested in receiving at TMCC?
*
(Required)
Are you taking any medication at the present time?
*
(Selection is Required)
Yes (Specify Below) Name of medication, dosage, reason for taking, side effects?
No
Additional Note or Comment
What is your career goal?
*
(Required)
How many credits are you currently enrolled at TMCC? Other Institution?
*
(Required)
Are you a participant in any scholarships or programs with a credit requirement?
*
(Selection is Required)
Yes (Specify Below) Please indicate the program and how many credits you are required to take.
No
Additional Note or Comment
How did you hear about our program?
*
(Required)
Navigation
Home
Online Services Home
Licensed to
Accessible Information Management LLC
Copyright © 2010-2023 by Haris Gunadi. All rights reserved.