Bismarck State College
Application/Intake For Student Accessibility
Bismarck State College, P.O. Box 5587, 1500 Edwards Avenue, Bismarck, ND 58506    701-224-5400 :: 800-445-5073
Personal Information         (* indicates required fields)
* Gender: Male Female
*Current Phone (Home): Cell Phone (if available): **E-mail Address:
** Please enter your email address if you wish to receive an email confirmation        
*When do you plan to start college at BSC?
Fall Spring Summer    *Year: 20   Major:
 *Degree Plan:    AA AS AAS Diploma Certificate Undecided
*Are you currently a client of Rehabilitation Consulting and Services (Vocational Rehabilitation)?   Yes No
If not, would you like information about this agency?   Yes No
*Have you applied for Federal Financial Aid?   Yes No

Disability Information:
(Check all that apply--it is necessary to supply current documentation from an appropriate professional to support each area of disability.)
Acquired Brain Injury ADD/ADHD Blind
Developmental Disability Hard of Hearing Visual Impairment
Deaf Health Impairment Speech/Language Impairment
Learning Disability Orthopedic Impairment Psychiatric Disability

Based on your documented disability, check the accommodations you will need to ensure equal access to academics. (Accommodation approval is based on supporting documentation of disability.)
Extended time on tests Tests read aloud Test writer
Reduced distraction testing Audio textbooks Adjustable table/stand
Large print materials Braille materials Cushioned seating
Note taker Record lectures FM amplifier
CCTV Sign language interpreter or captioning Ergonomic keyboard
Computer screen magnification speech to text software Other
Explain Other:

Understanding Disability Services in College
Bismarck State College is committed to providing reasonable accommodations for students with documented disabilities. Unlike elementary, middle and high schools, the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act of 1973 govern colleges and universities. Therefore, having an IEP or 504 plan while in high school does not automatically make you eligible for disability services in college. While we are committed to providing reasonable and appropriate classroom accommodations for documented disabilities so all students have an equal opportunity to work toward success, students who participate in college level curriculum will be expected to perform at the college level. Instructors are not expected nor encouraged to compromise requirements deemed essential to college coursework.

*Date (00/00/0000):
* I certify to the best of my knowledge that the information on this form is true and complete without evasion or misrepresentation. I understand that if found to be otherwise, it is sufficient cause for rejections or dismissal. By checking this box you have created an electronic signature as legal as your handwritten signature.

Thank you for your application.