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Join the CCN! - Consent Form

Who can Join?

CCN membership is for individuals with disabilities and seniors only. If you would like to receive notices about surveys to forward on to your members, clients, family or friends or to receive our newsletter, please email ccn@coa.gatech.edu and ask to be added to the non-members list.

You may help someone fill-out the CCN sign-up and subsequent surveys as long as you are only providing physical assistance.

Requirements for Individuals

Please read the requirements below before registering.

  1. Must be an individual with a disability or a senior
  2. Must have a valid email address
    The preferred method of contact for the CCN is email. It is also the way we identify individuals. Therefore, only use one email address per person AND one person per email address.

    If you do not have an email address or preferred to be called, you may be added to our phone list by emailing ccn@coa.gatech.edu. We do not use this list as often as our email list, so if you have an email address, we suggest that you use it.

  3. Please notify the CCN if you change email addresses or your abilities change.
  4. Please notify us at ccn@coa.gatech.edu if you have any problems.
     We rely on member feedback to make corrections to any correspondence or surveys including this form.

Consent Form

Please read and then select accept or decline below.


I have read and accept the terms and conditions. (opens in a pop up window)