Harrisburg Area Community College Student Access Services Referral Form

Student Information

Please enter your information.

Student's Legal First Name

Student's Preferred First Name

Student's Last Name

Student's Middle Name

Student's HACC Email

Student's HACC ID number

The HACC ID starts with an "H" Zero.

Student's Phone Number

I am a HACC student or future HACC Student

I am referring a current HACC student

Additional Information

Upload supporting document(s)

Thank you for completing our public request form.

Please keep in mind, Student Access Services strives to meet with students within two weeks of submission of documentation, depending on the volume of submissions. It is recommended that documentation be submitted well in advance of any accommodation related needs, so that we can ensure adequate processing time.

Harrisburg Area Community College Student Access Services Referral Form

Student Information

Additional Information

Thank you for completing our public request form.

Document Information