Skip to Main Content Skip to Tabs Skip to Sub-Tab Navigation

Get Started

Three easy steps to register
Personal Information
  1. Hint: G01234567
  2. Hint: Enter date in the following format Month / Day / Year (i.e. 12/31/2010).
Contact Information
  1. Hint: Enter 10-digit number only (i.e. enter 5417377000 for 541 737 7000).
  2. Hint: Enter 10-digit number only (i.e. enter 5417377000 for 541 737 7000).
  3. Note: If you already have PCC email address, please provide one.
Additional Information
  1. Note: Select when you would like to start your disability services.
  2. Note: Select when you plan to graduate.
Questions
  1. What brings you to Disability Services
  2. Were you referred by someone?
  3. Student Affiliation and Campus Services
  4. Did you graduate from high school?
  5. Did you complete a GED?
  6. Have you used accommodations in the past?
  7. Please indicate the type and nature of disability you experience
  8. Have you ever worked with a mental health practitioner?
  9. Do you take any medications that may influence your academics?
  10. FUNCTIONAL LIMITATIONS: I have difficulty or may need assistance with:
  11. How do you rate your own self-advocacy skills
Licensed to Accessible Information Management LLC . Copyright © 2010-2014 by Haris Gunadi. All rights reserved.