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Access Services for Students with Disabilities

Request Information About Access Services

Complete the form below or send in a printed form (information request in Word or information request in PDF).

Quarter of Registration

Fall

Winter

Spring

Summer

Year

First Name

Last Name

Address

Street Address

Address Line 2

City

State / Province / Region

Country

Phone Number

Email

Student ID

Please check the disability(ies) you identify with.

Acquired Brain Injury

Asperger's/Autism

Blind/Visual Impairment

Central Nervous System/Neurological Condition

Chronic/Acute Health Condition

Deaf/Hearing Impairment

Learning disability

Mobility Impairment

Psychological/Emotional Condition

Speech/Language Impairment

Other; please describe:

Other

Contact

Access Services for Students with Disabilities
Lib 2129
(360) 867-6348
Fax: (360) 867-6360

Hours

Mon – Fri 9 am – 5 pm

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The Evergreen State College

2700 Evergreen Parkway NW

Olympia, Washington 98505

(360) 867-6000

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—Omnia Extares—