ACCESS Registration/Intake Form

Intake form for ACCESS Program. This form initiates the process to sign up for services. If you have a disability or diagnosis that you require accommodations for, you must fill this out FIRST. If you don't hear from someone within 3 days, please make an appointment with us.

Please send all documentation to accessability@lipscomb.edu or fax it to (615) 966-5079.
If you have documentation available, please attach it here. If you don't, you can bring it with you to our meeting or fax it to (615) 966-5079.
Select a file on your computer (Max size 4 MB)
Select a file on your computer (Max size 4 MB)
Select a file on your computer (Max size 4 MB)