PREP Register

I plan to attend the program on: (select ONE you plan to attend)

August 11 (1-2:30pm)

August 16 (1-2:30pm)

Personal Information

First Name*

Last Name*

Preferred Name

Date of Birth*

How do you Identify?

He/Him/His

She/Her/Hers

They/Them/Theirs

Contact Information

Address:

Street

City

State

Zip Code

County

Phone Number*

Do you receive texts at this number?*

Primary Email Address*

College Information

Student M#*

When are you Starting MVCC?*

Do you have and open ACCESS-VR case?

Who / What led you to apply to the MVCC PREP program?

Accommodative information

Have you been diagnosed with a learning disability, ADHD, or ASD?

If yes, what is the diagnosis; If no, what is your documented disability?

Do you/ did you have an individualized Education Plan (IEP) or 504 in High School?

Have you ever attended College?

If yes, did you receive accommodation services?

What challenges you the most?hold ctrl when selecting multiple items

Your biggest concern with your transition to college?

Parents | Guardians | Advocates
The PREP program offers an information session when advocates can learn about ACCES-VR and ask individualized questions.
The session is a great opportunity to meet Accessibility staff and learn about disability-related services and accommodations at the
college level.

Are you interested in attending an information session from 3:00-4:00 on the same date your student attends the PREP program?

If yes, provide an email address that you check regularly

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