Public Accommodation Request

* indicates a required field

Self-Disclosure 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 and/or diagnoses 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.  

We will communicate important information with you via your Penn College email

Disability/Diagnosis Information

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

Please use this section of the form to upload documentation of your diagnosis. Documentation can also be provided using the contact information on our website.

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

Accommodated Placement Test Request

Please note that disability/diagnosis 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. 

Are you requesting accommodations for your Placement Test?Required