Self-Report Form Thank you for registering with the Center for Students with Disabilities. Please take a few minutes to provide us with some information in order to assist us in helping you. Name First Last PeopleSoft1. What difficulties are you experiencing?2. What type of assistance/accommodations are you seeking and why?3. What treatments and/or medications are you receiving (list names and doses if applicable)?4. Please provide any additional information you want us to know.