Skip to Main Content
Skip to Tabs
Skip to Sub-Tab Navigation
Sign In
Page Tabs
Home
You are here:
Home
Online Student Application
Online Student Application
Page Options
Personal Information
Start Term
*
:
Select One
2025 - Spring
2025 - Summer
2025 - Fall
2026 - Spring
2026 - Summer
2026 - Fall
2027 - Spring
2027 - Summer
2027 - Fall
2028 - Spring
2028 - Summer
2028 - Fall
2029 - Spring
2029 - Summer
2029 - Fall
2030 - Spring
2030 - Summer
2030 - Fall
2031 - Spring
2031 - Summer
2031 - Fall
2032 - Spring
2032 - Summer
2032 - Fall
2033 - Spring
2033 - Summer
2033 - Fall
2034 - Spring
2034 - Summer
2034 - Fall
2035 - Spring
2035 - Summer
2035 - Fall
2036 - Spring
2036 - Summer
2036 - Fall
2037 - Spring
2037 - Summer
2037 - Fall
2038 - Spring
2038 - Summer
2038 - Fall
2039 - Spring
2039 - Summer
2039 - Fall
2040 - Spring
2040 - Summer
2040 - Fall
2041 - Spring
2041 - Summer
2041 - Fall
2042 - Spring
2042 - Summer
2042 - Fall
2043 - Spring
2043 - Summer
2043 - Fall
2044 - Spring
2044 - Summer
2044 - Fall
2045 - Spring
2045 - Summer
2045 - Fall
2046 - Spring
2046 - Summer
2046 - Fall
2047 - Spring
2047 - Summer
2047 - Fall
2048 - Spring
2048 - Summer
2048 - Fall
2049 - Spring
2049 - Summer
2049 - Fall
2050 - Spring
2050 - Summer
2050 - Fall
Note: Select when you would like to start your services.
Expected Graduation Term:
Select One
2011 - Spring
2011 - Summer
2011 - Fall
2012 - Spring
2012 - Summer
2012 - Fall
2013 - Spring
2013 - Summer
2013 - Fall
2014 - Spring
2014 - Summer
2014 - Fall
2015 - Spring
2015 - Summer
2015 - Fall
2016 - Spring
2016 - Summer
2016 - Fall
2017 - Spring
2017 - Summer
2017 - Fall
2018 - Spring
2018 - Summer
2018 - Fall
2019 - Spring
2019 - Summer
2019 - Fall
2020 - Spring
2020 - Summer
2020 - Fall
2021 - Spring
2021 - Summer
2021 - Fall
2022 - Spring
2022 - Summer
2022 - Fall
2023 - Spring
2023 - Summer
2023 - Fall
2024 - Spring
2024 - Summer
2024 - Fall
2025 - Spring
2025 - Summer
2025 - Fall
2026 - Spring
2026 - Summer
2026 - Fall
2027 - Spring
2027 - Summer
2027 - Fall
2028 - Spring
2028 - Summer
2028 - Fall
2029 - Spring
2029 - Summer
2029 - Fall
2030 - Spring
2030 - Summer
2030 - Fall
2031 - Spring
2031 - Summer
2031 - Fall
2032 - Spring
2032 - Summer
2032 - Fall
2033 - Spring
2033 - Summer
2033 - Fall
2034 - Spring
2034 - Summer
2034 - Fall
2035 - Spring
2035 - Summer
2035 - Fall
2036 - Spring
2036 - Summer
2036 - Fall
2037 - Spring
2037 - Summer
2037 - Fall
2038 - Spring
2038 - Summer
2038 - Fall
2039 - Spring
2039 - Summer
2039 - Fall
2040 - Spring
2040 - Summer
2040 - Fall
2041 - Spring
2041 - Summer
2041 - Fall
2042 - Spring
2042 - Summer
2042 - Fall
2043 - Spring
2043 - Summer
2043 - Fall
2044 - Spring
2044 - Summer
2044 - Fall
2045 - Spring
2045 - Summer
2045 - Fall
2046 - Spring
2046 - Summer
2046 - Fall
2047 - Spring
2047 - Summer
2047 - Fall
2048 - Spring
2048 - Summer
2048 - Fall
2049 - Spring
2049 - Summer
2049 - Fall
2050 - Spring
2050 - Summer
2050 - Fall
Note: Select when you plan to graduate.
First Name
*
:
Last Name
*
:
Middle Name:
Optional: Preferred Name:
Student ID:
Hint: Enter 7 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Contact Information
Cell Phone Number:
Hint: Enter 10-digit number only.
Land Line Phone Number:
Hint: Enter 10-digit number only.
Email Address
*
:
Local Address
Address
*
:
City
*
:
State
*
:
Select One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Wyoming
International
Zipcode
*
:
Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address
Same as Local Address
Address:
City:
State:
Select One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Wyoming
International
Zipcode:
Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
Primary Disability
*
:
Select One
=== General Category ===
ADD or ADHD
Autism Spectrum Disorder
Blindness or Low Vision
Deafness or Hearing Loss
Diabetes
Head Injury
Learning Disability
Mental Health
Other
Physical Mobility, Dexterity, and Chronic Health-Related
Seizures
Speech
Secondary Disability(ies)
General Category
ADD or ADHD
Autism Spectrum Disorder
Blindness or Low Vision
Deafness or Hearing Loss
Diabetes
Head Injury
Learning Disability
Mental Health
Other
Physical Mobility, Dexterity, and Chronic Health-Related
Seizures
Speech
Other Disability or Note:
Seeking Degree:
Select One
Law Degree
MBA
MFA
MSDS
Post Baccalaureate
Undergraduate
Major:
Select One
American Ethnic Studies
Anthropology
Archaeology
Art History
Art, Studio
Arts, Technology and Multimedia
Asian Studies
BA/JD
BA/MBA
Biology
Chemistry
Chinese Studies
Civic Communication and Media
Classical Studies
Comparative Literature and the History of Ideas
Computer Science
Data Science
Economics
Engineering 3-2
English
Environmental and Earth Science
Exercise Science
Film Studies
Forestry 3-2 Program
French and Francophone Studies
German
History
Humanities
International Studies
Japanese Studies
Latin American Studies
Law degree
Mathematics
MBA
Medieval and Renaissance Studies
Music
Philosophy
Physics
Politics
Pre-Health
Pre-Law
Psychology
Religious Studies
Russian
Sociology
Spanish
Theatre
Women's and Gender Studies
Affiliation(s)
Affiliation(s)
Student Athlete
Veteran
Ethnicity(ies)
Ethnicity(ies)
No response needed
Campus Location(s)
Campus Location(s)
Atkinson Graduate School of Management
College of Law
PNCA
Salem Undergraduate
School of Computing and Information Sciences
Additional Note:
Please select accommodations and services that you have received prior to registering with Accessible Education Services. These can be accommodations and services provided at your high school or other college/university. If there are none, please leave any selections blank
Access Key to Eligibility Section is "G"
Prior Accommodations
Alternative Testing
Calculator
Computer for Screen Reader
Computer for Speech-to-Text
Computer for Word Processing
Enlarged Print Exams
Extra Time 1.25x
Extra Time 1.50x
Extra Time 2.00x
Reader
Reduced Distraction Location
Scribe or Typist
Short exam breaks as needed
Spellcheck (or No Penalty for Spelling Errors)
Alternative Formats
Accessible Electronic Text
Braille
Enlarged Print Text
Deaf and Hard of Hearing Access Services
Assistive Listening Device
Captioned Media
Interpreting
Real Time Captioning
Real Time Transcribing
Notetaking Services
Adaptive Technology for Note Taking
Notetaking
Smart Pen
Voice Recorder
Classroom Access
Accessible Classroom/Classroom Relocation
Accessible Fieldtrips
Accessible Table
Chair - Lumbar Support
Classroom Assistant
Foot Stools
Lab Assistant
Preferential Seating
Mobility Device (Student Owned)
Wheelchair Access
Housing Accommodations
Emotional Support Animal
Housing Accommodation
Please select services you are SEEKING with our office, and provide documentation for your eligibility for those services
Access Key to Eligibility Section is "G"
Requesting Accommodations at AES
Alternative Testing
Calculator
Computer for Screen Reader
Computer for Speech-to-Text
Computer for Word Processing
Enlarged Print Exams
Extra Time 1.25x
Extra Time 1.50x
Extra Time 2.00x
Reduced Distraction Location
Scribe or Typist
Short exam breaks as needed
Spellcheck (or No Penalty for Spelling Errors)
Alternative Formats
Accessible Electronic Text
Braille
Enlarged Print Text
Deaf and Hard of Hearing Access Services
Assistive Listening Device
Captioned Media
Interpreting
Real Time Captioning
Real Time Transcribing
Notetaking Services
Adaptive Technology for Note Taking
Classroom Access
Accessible Classroom/Classroom Relocation
Accessible Fieldtrips
Accessible Table
Chair - Lumbar Support
Foot Stools
Preferential Seating
Mobility Device (Student Owned)
Wheelchair Access
Housing Accommodations
Emotional Support Animal
Housing Accommodation
Questions
What services are you applying for?
Academic accommodations for documented disabilities
Housing accommodations for documented disabilities
Additional Note or Comment
Who referred you to Accessible Education Services?
Academic Advisor
Another Willamette Student
Bishop Wellness Center
Coach
Compass Mentor
Parent
Professor
Residence Life (RA, Area Coordinator)
Self
Web Site
Other (Specify Below)
Additional Note or Comment
Are you a student with a disability?
*
(Selection is Required)
Yes, I have a diagnosed disability (Specify Below)
I suspect I have a disability, but I am not diagnosed (Specify Below)
No, I do not have a disability
Additional Note or Comment
If you have or suspect that you have a disability, please describe how your disability affects you in a learning and/or residential environment.
Would you like to provide any additional information about how your disability affects your academic functioning or living environment (e.g., prescription side effects, physical illness, injuries, surgeries, etc.)?
Please check the major life activities with which this condition interferes:
Walking
Standing
Seeing
Hearing
Sleeping
Eating
Lifting
Bending
Reading
Speaking
Breathing
Learning
Communicating
Working
Thinking/concentrating
Manual tasks
Organization
Other (Specify Below)
Additional Note or Comment
Which learning skills do you want to improve?
Time Management (scheduling time, making lists, setting priorities)
Reading Strategies
Notetaking Strategies
Test Preparation Strategies
Taking Multiple Choice Tests
Managing Test Anxiety
Writing Strategies
Additional Note or Comment
Navigation
Home
Online Services Home
Licensed to
Accessible Information Management LLC
Copyright © 2010-2025 by Haris Gunadi. All rights reserved.