The Accessibility Office Initial Pre-Intake Form

Please be sure you have your PDF documentation available to upload before completing the form.

* indicates a required field

Student Information

You must be a registered Bucks student in order register for accommodations with TAO.

First Name

Last Name

Birthday

Student ID

Bucks Email

Please use your Bucks email account

Cell Phone Number

Select your disability/disabilities

Choose all that apply

If other, please specify

What medications, if any, do you receive?

What is your current enrollment status?

Which campuses do you utilize? Please choose all that apply

How does your disability impact you in the academic setting/classroom?

What accommodations have you received in the past? Which ones were helpful; which were not?

What accommodations are you requesting with the Accessibility Office?

Upload supporting document(s)

Documentation examples include: IEP, 504 plan, psychological testing, verification forms, doctor's letter. Please send in PDF format.