Online Student Application

1. Start Term *: Select One 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
   Note: Select when you would like to start your services.
2. Expected Graduation Term: Select One 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
   Note: Select when you plan to graduate.
3. Preferred Name *:
4. Last Name *:
5. Middle Name:
6. Legal First Name:
7. Student ID:
   Hint: Enter 9 alpha numeric characters.
8. Birth Date:
   Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
9. Gender *: Select One Female Gender not listed Male Non-Binary Not Specified Trans man Trans woman
10. Pronouns: Select One He/Him He/They Prefer not to answer Preference not listed She/Her She/They They/Them Ze/Zir

1. Primary Phone Number:
   Hint: Enter 10-digit number only.
2. Secondary Phone Number:
   Hint: Enter 10-digit number only.
3. Email Address *:

1. Address *:
2. City *:
3. 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
4. Zipcode *:
   Hint: Enter zipcode as 97331 or 97331-0000.

Same as Local Address

1. Address:
2. City:
3. 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
4. Zipcode:
   Hint: Enter zipcode as 97331 or 97331-0000.

1. Primary Disability *: Select One === General Category === Acquired Brain Injury (ABI) Attention-Deficit Hyperactivity Disorder (ADHD) Autism Spectrum Disorder Blind, Low Vision, or Vision (Other) Concussion Deaf or Hard of Hearing Intellectual Disability Learning Disability Mental Health Disability Other Health Condition or Disability Physical Disability Temporary Disability
2. Secondary Disability(ies)

   General Category

   Acquired Brain Injury (ABI)

   Attention-Deficit Hyperactivity Disorder (ADHD)

   Autism Spectrum Disorder

   Blind, Low Vision, or Vision (Other)

   Concussion

   Deaf or Hard of Hearing

   Intellectual Disability

   Learning Disability

   Mental Health Disability

   Other Health Condition or Disability

   Physical Disability

   Temporary Disability
3. Other Disability or Note:
4. Seeking Degree: Select One Bachelor's Degree Master's Degree
5. Major: Select One Accounting Adventure Education Anthropology Art K-12 Education Biochemistry Biochemistry Secondary Education Biology Biology Secondary Education Borders and Languages Business Administration Chemistry Chemistry Secondary Education Communication Design Computer Engineering Computer Information Systems Criminology and Justice Studies Digital Marketing Certificate Early Childhood Education Economics Educational Studies Elementary Education Engineering English English Secondary Education Entrepreneurship and Small Business Environmental Conservation Management Environmental Science Environmental Studies (ended 2019-2020) Exercise and Health Promotion Exercise Physiology Exercise Science K-12 Education Gender and Sexuality Studies Geographic Information Systems (GIS) Certificate Geology Gerontology Certificate Health Sciences History History Secondary Education Journalism and Multimedia Studies Marketing Mathematics Mathematics Secondary Education Music Music Business Music Education Music Performance Native American and Indigenous Studies Nutrition Philosophy Physics Political Science Pre-Health Certificate Psychology Public Health Regenerative Food Systems Certificate Ski Operations Certificate Sociology and Human Services Sport Administration Studio Art Theatre Theatre K-12 Education World Language Secondary Education Writing

Affiliation(s)

6. Affiliation(s)

   Department of Vocational Rehabilitation

   Fort Lewis Counseling Center

   STEM-3 Student Success Center

   Student Athlete

   Student Success Coach

   TRIO Student Success Center (PAA)

   Veteran

Ethnicity(ies)

7. Ethnicity(ies)

   American Indian or Alaskan Native

   Asian

   Black or African American

   Choose Not to Answer

   Hispanic

   Multi-Racial

   Native Hawaiian or Other Pacific Islander

   Other

   White
8. Additional Note: