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Create a New Account
Fill out the form below in order to create a new account on this system. Questions marked with a * are required.
Email Address:
 *
First Name:
 *
Last Name:
 *
Telephone Number:
*
Student ID Number (please enter your ID provided by the institution that you belong to):
*

 

Select one of the following::
*
Are you registered with Accessible Learning Services (ALS):
*

 

If you are registered with ALS, please specify your accommodations, starting with EXTENDED TIME:

 

Please select additional ALS accommodations as listed on your accommodation form.:

  SPECIALIZED SOFTWARE - Kurzweil

  SPECIALIZED SOFTWARE - Dragon

  SPECIALIZED SOFTWARE - ZoomText

  SPECIALIZED SOFTWARE - OTHER

  VISUAL AID - Magnifier

  VISUAL AID - CCTV

  VISUAL AID - Enlarged Text

  Ergonomic Chair

  Adjustable/Electric Desk

  Large Desk

  Testing Carrel + Computer (not available at Davis)

  Quiet Room

  Separate Room

  Standard Calculator

  Programmable Calculator

  Scribe

  Reader

  Scribe and Reader

  Spelling Dictionary

  Regular Dictionary

  Spell Check Software

  Memory Aid Sheet

  Formula Sheet

  Stand-Alone Computer

  Laptop

  Network Access

  Clarification

  Short Breaks

Password
Password:
 *
Re-Enter Password:
 *
Email Options
Send an Email:

When I make an appointment.
When I modify an appointment.
When I delete an appointment.
When an announcement or mass email is sent.
To remind me of my upcoming appointment.
Include iCal Link?

Text Message Options:

You have the option of receiving appointment reminders and waiting list "appointment available" notices via text message instead of via email. If you would prefer to receive text message notices, enter your ten-digit cell phone number and select your carrier below.

Charges may be incurred by sending text messages to your cell phone. You are agreeing to be responsible for such charges by using this optional feature.

CELL PHONE NUMBER (TEN DIGITS, NUMBERS ONLY):

CELL PHONE CARRIER: