Public Accommodation Request

* indicates a required field

Self-Disclosure and Documentation Form

If you need assistance in completing this form, please contact Disability and Access Resources. 

Pennsylvania College of Technology 
provides appropriate accommodations to students with documented disabilities who elect to disclose their needs.  Completing this form and submitting documentation will assist staff in understanding how to best support you in your courses, programs, and activities.  

Preferred Email AddressRequired

Disability and Access Resources will send all communication exclusively to your student email account unless you indicate that you would also like communication sent to a second email address. By selecting "Yes", you give Disability and Access Resources permission to forward disability-related communication to you (the student) using an alternate email address temporarily until you are an enrolled student.  

Specific Disability Information

To select multiple disabilities, please use the "select" dropdown menu again.
(testing, housing, note taking, etc.)
Upload supporting document(s)

Please use this section of the form to upload documentation of your disability. If you have multiple files, please click "Add item" to upload additional documentation. If you wish, you can also mail, fax, or hand deliver your documentation to Disability and Access Resources. Fax: 570-327-4501. Mail: Pennsylvania College of Technology DIF 59 One College Ave Williamsport, PA 17701

Please type first and last name to indicate that the information on this form is accurate and complete.

Accommodated Placement Test Request

Accommodations for placement testing are based on the history of services and testing accommodations that you received in a previous learning environment. Please note that disability documentation is not required for your Accommodated Placement Test Request. Documentation will, however, be required to determine eligibility for accommodations and services once an enrolled student and will be reviewed upon submission. Documentation can be uploaded to this form or sent directly to Disability and Access Resources.