Online Student Application

Disability Access Services (DAS) helps ensure that all students with disabilities have equal access to programs at Western Oregon University (WOU). DAS arranges reasonable accommodations in accordance with the ADA and Section 504 of the rehabilitation Act of 1973. the accommodations provided vary as each case is evaluated individually.

Please complete this application and submit appropriate documentation once you have been accepted into WOU.

Personal Information

Start Term *:
Note: Select when you would like to start your services.
Primary Campus *:
Note: Please select campus location where you will be enrolled.
Expected Graduation Term:
Note: Select when you plan to graduate.
First Name *:
Last Name *:
Middle Name:
Legal Name (if different):
Student ID:
Hint: Enter 9 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Pronouns:

Contact Information

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

Local Address

Address *:
City *:
State *:
Zipcode *:
Hint: Enter zipcode as 97331 or 97331-0000.

Permanent Address

Same as Local Address

Address:
City:
State:
Zipcode:
Hint: Enter zipcode as 97331 or 97331-0000.

Additional Information

Prior Accommodations

Requesting Accommodations at DAS

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Disability Access Services

Western Oregon University
345 N. Monmouth Ave., APSC 405
Monmouth, OR 97361

Website: http://www.wou.edu/disabilityservices/
Email Us: ods@wou.edu

Phone: (503) 838 - 8250
Fax: (503) 838 - 8721

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