College students with mental health concerns and disabilities are at risk for poorer academic outcomes. Utilization of student support services (TRIO, disability services, and student counseling services) can mitigate these issues. However, utilization patterns and the service delivery process are not well understood in the South Dakota Board of Regents (SDBOR) system. This study aimed to investigate 1. The extent to which students utilize mental health and disability services in the South Dakota Board of Regent (SDBOR) University system. 2. How service providers deliver those services to students. Utilizing a cross sectional survey and grounded theory design, researchers found that most students (76.67%) were not registered with the office of disability services, however a need for mental health services exists. Additional findings conclude a low perception of stigma relating to mental health and disability service use, (59) =18.78,p\u3c.001, Cohen’s d=2.93 and a high perception of need for mental health services , t(59)=-.176,p\u3c.001, Cohen’s d=2.93. Additionally, qualitative data indicated that the service delivery process consisted of Triage, Supporting Student Success, and Promoting Student Wellness. The results of this study suggest a need for additional mental health and individualized services at SDBOR universities. Occupational therapy could be useful in addressing the needs of college students within the SDBOR system; however, future research should be conducted to articulate these needs and define the role of occupational therapy practitioners in higher education