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Online Student Application

Two easy steps to register
Welcome to the Access Services registration process. Please fill in the form as completely as possible.
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.
Additional Information
  2. Secondary Disability(ies)

    Acquired Brain Injury

    ADHD

    Autism Spectrum Disorder

    Blind/Vision Impaired

    Deaf/Hard-of-Hearing

    General Category

    Physical/Mobility

    Psychological

    Specific Learning Disability

    Systemic Health

    Temporary Disability

  4. Affiliation(s)
Questions
  1. I am: *
  2. I am requesting accommodations for:
  4. Please select the type of documentation you have:
  5. Did you have an IEP or 504 plan in high school? *
  8. I grant permission for Access Services to include our connection in the Customer Relationship Management System at Western Technical College. *
Submission of this request does not imply you will receive services. In addition to this application, in order to be eligible for disability related services, students must have a documented disabling condition as defined by the Americans with Disabilities Act of 1990 (ADA), ADA Amendments Act 2009 and Section 504 of the Rehabilitation Act of 1973.

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