Access Services for Students with Disabilities

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Access Evergreen Form

Do You Know ...

Access Services works to ensure students with disabilities have equal access to Evergreen's academic programs and activities. If you have a disability and would like to receive information about Access Services, please complete this form.

Today's Date:
Quarter of Registration:




Year:
Name:
Address:
City: State: Zip:
Phone:

Please check the disability with which you most closely identify:

Acquired Brain Injury
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: