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Online Student Application

Two easy steps to register
Please complete the form below to initiate your request for services. Your responses below will not impact your potential eligibility for services. After you have submitted the form, Student Accessibility Services staff will contact you to schedule an initial interview appointment.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  7. Hint: Enter 9 alpha numeric characters.
  8. Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Contact Information
  1. Hint: Enter 10-digit number only.
  2. Hint: Enter 10-digit number only.
Local Address
  4. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address

  4. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  2. Secondary Disability(ies)

    General Category

  5. Affiliation(s)
  6. Ethnicity(ies)
  7. Campus Location(s)
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