UNC Chapel Hill: Disability Services: Eligibility for Services

Every student has the opportunity to voluntarily self-identify with the University as having a disability or medical condition that may impact access to the programs and activities of the University. Self-Identification is available on-line through C-TOPS (Carolina Testing and Orientation Program), to graduate/professional students through individual departments or schools, and to part-time students through Continuing Studies and Summer School. Self-ID forms are also available on this website.
Note: Identifying oneself as having a disability, to an individual professor, school, or department other than DDS, IS NOT considered an official notification to the University.

If you have a disability/chronic medical condition, we encourage you to complete this form and return it directly to the Department of Disability Services. Upon receipt of this form, in most instances we will request that you provide documentation from your primary care physician or other professional care provider about the current functional limitation(s) your medical condition imposes on you while you are enrolled at UNC Chapel Hill. This documentation will be held in confidence.

Date : (mm/dd/yy)

Name :

Personal Identification Number (PID):

Email Address :

Telephone Number :

Education Classification:

Undergraduate Graduate/Professional Continuing Studies
Distance Education

Program of Study (Business, Nursing, Law, etc.)

Mailing Address :

Type of Disability/medical condition :
Multiple limitations can be selected by pressing the Control Key while selecting each item.

If Other, please specify :

Associated Limitations :
Multiple limitations can be selected by pressing the Control Key while selecting each item.

If Other, please specify :

Accommodations Requested :

Is this disability... Temporary Permanent

If Temporary, expected time until recovery?

Are you registered to vote? Yes No

Questions, comments? Email us at disabilityservices@unc.edu
(919) 962-8300