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Registration Form

Two easy steps to register
Welcome to Access Services for Students with Disabilities. Please complete the form below in its 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.evergreen.edu/registration/confidentiality.
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.

Questions

  1.  
    Have you used accomodations in your previous school experience? * (Selection is Required)
  2.  
    Are you requesting accommodations for any of the following (check all that apply):
  3.  
    Are you receiving services through any of the following:
  4.  
    How did you learn about Access Services? (check all that)
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