SDS Registration Form

Student Information

First Name

Last Name

Middle Name

Hopkins ID

(NOT your JHED ID); If you do not know your Hopkins ID, please log into Student Self Service and check the upper right corner. Medical students can look under "My Profile" on the myjh.edu portal.

JHU Email

Personal Email

Phone Number

Pronouns

Student Identifiers

Please check all that you identify with

Please check here if English is not your first language

Academic Information

First Term or Program Start Date at JHU

What is your school?

Department/Center/Institute/Program

Are you earning dual degrees?

Anticipated Date of Graduation

(Month/Day/Year)

How did you learn about Student Disability Services?

Disability Information and Previous Accommodations

Please describe your diagnosed disability(ies), listing your primary one first:

Describe in as much detail as possible how the diagnosed condition is currently impacting you

Describe any accommodations and services you have used in the past

If you have used any medical or educational interventions to manage the diagnosed condition, please explain.

Describe what these were and how and why they have or haven't helped.

Please describe any relevant disability related medications you are taking that may impact your functioning.

Please indicate Assistive Technologies you have used or are interested in trying.

If Other, please describe below:

For Students Who Receive Agency Services

Skip if this section does not apply to you

Do you currently receive assistance from any of the following?

Name of counselor

Counselor's Email

Agency Name

Current Accommodations Request

Please describe the accommodations you are currently requesting.

Upload supporting document(s)

Please refer to the SDS Documentation Guidelines for information about what is needed to document a disability. Our Documentation Form outlines the information needed and should be completed by your provider.

Confidentiality Statement (Optional)

If there are additional questions pertaining to my documentation, I give Disability Services permission to contact the professional who completed the evaluation to obtain further information so that we can appropriately determine eligibility of services