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PREP Register
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accessibility resources
PREP Register
If you see this don't fill out this input box.
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
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
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
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
County
Phone Number
*
Do you receive texts at this number?
*
Please Select
Yes
No
Primary Email Address
*
College Information
Student M#
*
When are you Starting MVCC?
*
Please Select
Fall 2022
Spring 2023
Do you have and open ACCESS-VR case?
Please Select
Yes
No
Who / What led you to apply to the MVCC PREP program?
Please Select
It was mailed
ACCESS-VR
Guidance Counselor
MVCC Staff / Faculty
Resource room teacher
MVCC Website
Other
Accommodative information
Have you been diagnosed with a learning disability, ADHD, or ASD?
Please Select
Yes
No
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?
Please Select
Yes
No
Have you ever attended College?
Please Select
Yes
No
If yes, did you receive accommodation services?
Please Select
Yes
No
What challenges you the most?
Note Taking
Studying
Reading
Test Taking
Focusing
Asking / knowing when to ask for help
Staying Organized
Time Management
Written Expression
Socializing / Communicating
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?
Please Select
Yes
No
If yes, provide an email address that you check regularly
Form UUID
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