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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
Required
*
Last Name
Required
*
Date of Birth
Required
*
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Student ID
Required
*
Bucks Email
Required
*
Please use your Bucks email account
Cell Phone Number
Required
*
DISABILITY INFORMATION
Select your disability/disabilities
Required
*
Choose all that apply
[select]
ASD Related
Attention Deficit/Hyperactivity
Chronic Health
Cognitive
Communication
Hearing
Neurological
Psychological
Specific Learning Disability
Temporary
Visual
Other
clear
{"display_name":"Select your disability\/disabilities","hidden_field_name":"ms_field_1","init_id":"ms_field_1","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
If other, please specify
What medications, if any, do you receive?
Enrollment Status
What is your current enrollment status?
Required
*
New Student
Transfer Student
Guest Student
Currently Enrolled
Which campuses do you utilize? Please choose all that apply
Newtown
Bristol
Perkasie
Bucks Online
Fire School
ACADEMIC ACCOMMODATIONS
How does your disability impact you in the academic setting/classroom?
Required
*
What accommodations have you received in the past? Which ones were helpful; which were not?
What accommodations are you requesting with the Accessibility Office?
Required
*
DOCUMENTATION of DISABILITY
Upload supporting document(s)
Required
*
Documentation examples include: IEP, 504 plan, psychological testing, verification forms, doctor's letter. Please send in PDF format.
Drop files here to upload
Upload File