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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.
  2. Hint: Enter 10-digit number only.
  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 during previous educational/employment experiences?
  2. Do you have or can you obtain current documentation of your disability (or temporary medical condition)?
  3. If you do not have current documentation, would you like some one from ADS to contact you to talk about options and next steps? Please be aware that not having current documentation does not automatically disqualify you from receiving services through ADS.
  4. Are you receiving educational benefits through any of the following:
  5. (Optional Question) Do you participate in any of the following programs (check all that apply):
  6. How did you learn about ADS? (Check all that apply)
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