NAME ___________________________________ TR _____ FYS _____

BIRTHDATE ________________ SOCIAL SECURITY #__________________

ADDRESS ___________________________________________________
____________________________________________________________

PHONE# _________________________ EMAIL _____________________

SCHOOL/ADDRESS _____________________________________________
_____________________________________________________________
_____________________________________________________________

GUIDANCE COUNSELOR ______________

EST GRAD DATE _________            ENTERING DATE ___________

1. HOW DID YOU HEAR ABOUT BARNARD COLLEGE?

Admissions Recruiter ___ Barnard Alumna ___ Barnard Student ___

Friend ___ Guidance Counselor ___ Relative ____ Other ____

2. HOW DID YOU HEAR ABOUT THE OFFICE FOR DISABILITY SERVICES?

Admissions Recruiter ___ Barnard Alumna ___ Barnard Student ___

Friend ___ Guidance Counselor ___ Relative ___ Other ___

3. DATE OF YOUR INTERVIEW WITH BARNARD ADMISSIONS? __________

Interviewer's Name _____________________________________

4. DID YOU HAVE A CAMPUS TOUR? Yes__ No__

OPTIONAL:

Section 504 of the Rehabilitation Act of 1973 specifically prohibits any pre-admission inquiries about an applicant's disability/handicap. However, a college or university may under Section 504 make a pre-admission inquiry if it is strictly voluntary and the primary purpose of the inquiry is clearly stated. ODS is interested in your response to the following questions so that we may analyze data pertaining to applicants with disabilities.

1. Do you have a disability? Yes/No Describe:

2. Do you intend to self-identify in your application? Yes__ No__
3. Did you take a nonstandard administration of the SAT? Yes__ No__
4. What accommodations were used in your previous school?

ODS 8/08

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