DRC Student Registration Form

* indicates a required field

Student Information

Please enter your information

First Name

Last Name

Middle Name

Student ID

Please use your university issued email address

Student Phone Number

Are you a Health Science Student?

AHS, CON, COM, DENT, JACSW, PHARM, SPH

Specific Accommodation Information

My diagnosed disability(ies) best fall into the following category(ies)

Of the items selected above, which do you consider your primary disability.

How does your disability affect you academically?

How does your disability affect student life in general, like housing and transportation?

What, if any, accommodations have you received in the past?

What additional information would you like DRC to know about your request?

What accommodations are you requesting

Upload supporting document(s)

You may also upload your supporting medical documentation to our Protected Health Information (PHI) link found here.

Next Step in DRC Registration Process

I understand that the next step in the DRC Registration process is to contact the Disability Resource Center at 312-413-2183 or at drc@uic.edu to schedule an Intake Appointment with a Disability Specialist.

DRC Student Registration Form

Student Information

Specific Accommodation Information

Document Information