DSS Student Information Form

Welcome

Welcome to Disability Services for Students (DSS) at Sonoma State University. The information you provide on this form is for us to recommend services appropriate for your needs and for our general reporting purposes. All information is held confidential.

Instructions

Complete each page and click the "Next" or "Submit button at the bottom of the page.

Need Help Completing the Form?

If you need assistance with the form, please email DSS at (disability.services@sonoma.edu), call 707-664-2677 (dial 711 for Relay) or stop by our office in Schulz 1014A.

Q1. Student SSU ID (nine-digit number)

Q2. Student Name

First Name

Last Name

Q3. Preferred Name

Q4. Pronoun(s)

Q5. Month and Day of Birth. Example, 03/31. Do not list year.

Q6. Telephone Number, example 707-664-2880:

Telephone number including area code

Q7. Personal Email:

Q8. SSU Email (Example: lobo@sonoma.edu)

Q9. Permanent Address

Street Address, Line 1

Street Address Line 2

City

State / Province

Postal / Zip Code