Disability Registration Form

* indicates a required field

Student Information

Admitted or enrolled students who believe they have a current and essential need for disability accommodations are responsible for registering with, and requesting accommodations through CASS. Unless the disability is obvious, the student must provide CASS with qualifying documentation verifying the nature and extent of the disability prior to receiving any accommodations. CASS will make every effort to provide reasonable accommodations for otherwise qualified students with disabilities.

Disability/Medical Condition Information

Specify your disability type(s)/medical conditionRequired
Check all that are applicable
If you selected Psychological as a disability type above, please list your specific diagnosis.
If you selected Physical, mobility or chronic medical condition as a disability type above, please list your specific diagnosis.
Do you have a disability that would hinder you from evacuating a building in an emergency?Required
If you answer yes, CASS will contact Security to inform them and they will follow up with you to schedule a time to discuss/develop a plan for evacuation in the event of an emergency.

Student Narrative/Statement on Impact

This section is a self-reported supplement to the disability/temporary medical condition documentation you submit. Please describe the limitations you experience, and how they impact your academic performance/participation in Caltech’s programs/campus. This information helps us better understand your reason(s) for requesting accommodations at Caltech.

(e.g. reading, writing, concentation, memory, time management, note-taking, etc)

If applicable, describe how your disability affects your daily activities, campus mobility, social interactions, etc.

If you are requesting services/accommodations for the first time, please describe the reason(s) accommodations were not previously needed.

Upload supporting document(s)
Need Help?

Should you have questions about completing this form, your disability documentation or anything else related to accommodations, please contact CASS at cass@caltech.edu.

Reminder

Please allow up to 30 days for reviewing your request, once the CASS Registration Form, Confidentiality Agreement and Release of Information Form, AND all other relevant documentation have been submitted. A meeting with CASS will be scheduled once the paperwork is received.