Request to Register with Services for Students with Disabilities

* indicates a required field

Student Information

Please enter your information
Please use your university issued email address
Were you referred to SSD by HYPE?
{"display_name":"Which School are you enrolled in?","hidden_field_name":"ms_field_1","init_id":"ms_field_1","init_link":"","has_autocomplete":false,"has_hierpicklist":null}

Specific Disability Information

(These include asthma, allergies, arthritis, migraines, seizures, etc.)
Academic areas impacted by disability
{"display_name":"Non-academic areas impacted by disability (please select all that apply)","hidden_field_name":"ms_field_2","init_id":"ms_field_2","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
Upload supporting document(s) (e.g. Most Recent Psychological Educational Evaluation, Neuropsychological Evaluation, Optional Provider Form)

Please refer to https://www.binghamton.edu/ssd/prospective-students/documentation-requirements.html