Get Intake Form - Bronx Community College - Cuny - Bcc Cuny

Filling out the Intake Form for Bronx Community College's Office of Disability Services is an important step in obtaining the support you need. This guide provides clear instructions on how to complete the form online, ensuring that all required information is accurately provided.

Follow the steps to effectively fill out the form.

1. Press the ‘Get Form’ button to access the Intake Form online. This will allow you to open the document in an editable format.
2. Begin by filling out the personal information section. Enter your CUNYfirst ID number, current date, full name (last name, first name, and middle initial), mailing address, and telephone number. Ensure all details are accurate to facilitate communication.
3. Provide your country of birth and date of birth in the specified format. Ensure the date follows the MM/DD/YYYY format for clarity.
4. Input your email address, making sure to use your Bronx Community College email address since communication will be directed there.
5. Indicate your marital status by selecting one of the available options: single, married, or domestic partner. This information helps the office understand your support network.
6. Select your gender from the options provided. If applicable, indicate whether you have children and specify who you live with and who referred you to the office.
7. Describe your disability in the relevant section and specify whether it is temporary. If you require transportation assistance, indicate if you use Access-A-Ride.
8. Move to the education section. Provide the name of your high school, the city and state, and indicate your graduation year or if you had an Individualized Education Plan.
9. Answer questions about your college history, including whether this is your first time attending college classes, if you attended a vocational training program, and your parents' college attendance.
10. In the employment section, state whether you are currently working and if so, how many hours per week.
11. Share any interests in employment and career-development discussions with a CUNY LEADS Advisor regarding your career goals and future education plans.
12. Complete the supports and services section by indicating any assistance you currently receive, such as Social Security benefits or public assistance.
13. Identify which life activities are affected by your disability by marking the relevant options in the checklist provided.
14. Disclose any medication related to your disability, including specifics and the names of medications, if applicable.
15. In the assistive devices section, indicate any technology or devices that assist you in your daily life.
16. Confirm any prior services you have utilized in an academic setting, particularly assistive technology and classroom accommodations.
17. After completing the form, review all entered data for accuracy. Make any necessary corrections.
18. Once satisfied with your entries, save the changes. You will have the option to download, print, or share the completed form.

Take the next step in securing your support—complete the Intake Form online today.