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Online Student Application

Two easy steps to register
College of the Siskiyous provides educational services and access for eligible students with documented disabilities who intend to pursue coursework at College of the Siskiyous. A variety of programs and services are available which afford eligible students with disabilities the opportunity to participate fully in all aspects of college programs and activities through appropriate and reasonable accommodations.

Completion of this form constitutes an agreement to apply for DSPS.

Student Responsibilities:

- I will provide DSPS with the information, documentation and/or forms (medical, educational, etc.) deemed necessary by DSPS to verify my disability(ies).

- I will meet with the DSPS Director/Counselor to complete a Student Educational Contract, and agree to meet with the Director/Counselor each semester to update the Student Educational Contract.

- I will utilize DSPS services in a responsible manner. I understand that DSPS uses written service provision policies and procedures that must be adhered to for continuation of services.

- I will comply with the student Code of Conduct adopted by the college.

- I understand those policies and procedures are available to me on the DSPS website under "DSPS Student Handbook", or can be mailed to my physical address upon request.

If you are unable to access any content on this form, or have queries, please email for assistance.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  3. Hint: Enter 9 alpha numeric characters.
  4. Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Contact Information
  1. Hint: Enter 10-digit number only.
  2. Hint: Enter 10-digit number only.
Local Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  1. Secondary Disability(ies)

    General Category

  2. Affiliation(s)
  3. Ethnicity(ies)
  4. Campus Location(s)
  1. Please select your student status: *
  2. Are you registered for classes and have you completed the College of the Siskiyous SOAR program? *
  3. By checking "yes" below, I affirm that I understand and agree with the DSPS Program Student Responsibilities and I will abide by them. *
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