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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: * (Selection is Required)
  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? * (Selection is Required)
  8.  
    I grant permission for Access Services to include our connection in the Customer Relationship Management System at Western Technical College. * (Selection is Required)
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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