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Online Student Application

Two easy steps to register
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Welcome to Access and Disability Services, Pierce College. Please complete the form below in it's entirety. This will help us serve you better!

Please know that the information you provide will be kept private in accordance with the Family Education Rights & Privacy Act (FERPA). For more information on FERPA, please visit: http://www.pierce.ctc.edu/ferpa
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  3. Hint: Enter 9 alpha numeric characters.
  4. Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Contact Information
  1. Hint: Enter 10-digit number only (i.e. enter 9998888888 for 999 888 8888).
  2. Hint: Enter 10-digit number only (i.e. enter 9998888888 for 999 888 8888).
  3. Hint: Please enter your school email address (i.e. email@smail.pcd.edu).
Local Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Questions
  1. Have you used accommodations in your previous school/employment experience?*
  2. Are you requesting accommodations for any of the following (check all that apply):
  3. Are you receiving educational benefits through any of the following:
  4. How did you learn about ADS? (Check all that apply)
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