Oglala Lakota College Survey of

Students with Disabilities

The College has a need for information about disabilities to justify programs such as Student Support Services (SSS). Please see OLC Disability Policy # 85-600.

Students who are disabled may self-identify according to the attached list of disability definitions, and please also indicate if you qualify as low income under the Trio funded programs such as SSS. The information you submit below will remain confidential, and will be used only for the educational purposes. This is your self-identification- you may revoke it at any time.

Student ID#

Disabled

Y
N

Disability Claimed

Low Income

Y
N

Click below for information
http://www.ed.gov/about/offices/list/ope/trio/incomelevels.html

Form prepared by

Self
College Personnel
Other such as Parent or Guardian

Thank you for your assistance

Student Support Services program

http://www.olc.edu/~cdelong/perseus.html