Disability Services Center

DSC Initial Appointment Form

Please complete prior to your appointment.

Enter your name.
Enter your pronouns, if you use them. Some examples are she/her/hers, they/them/theirs, he/him/his.
Enter your date of birth.
Enter your phone number. If you have multiple, please list them here.
Enter your @maine.edu email address.
Is the best way to leave a message through your cell phone or home phone?
Enter whether or not you would like to enter an emergency contact.
Enter the name of your emergency contact.
Enter your relationship to your emergency contact.
Enter the phone number of your emergency contact.
Select the reason why you are scheduling an appointment with the DSC.
Enter whether or not you receive services from the VA or from Vocational Rehabilitation.
Enter the name of your counselor at the Veterans Administration or Vocational Rehabilitation.
Enter your counselor's phone number.
Enter your experience using accommodations at work or at school, and whether or not they helped.
Enter the barriers you've experienced or anticipate experiencing in classes or on campus.
Enter the resources available to you that you plan on accessing in college.