Public Accommodation Request

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Self-Disclosure and Documentation Form

If you need assistance in completing this form, please contact Disability Services. 

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.  
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Preferred Email Address(Required) *

Disability Services will send all communication exclusively to your student pct.edu email account unless you indicate that you would also like communication sent to a second email address. By selecting "Yes", you give Disability Services 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

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To select multiple disabilities, please use the "select" dropdown menu again.
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(testing, housing, note taking, etc.)
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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 the Disability Services Office. Fax: 570-327-4501. Mail: Pennsylvania College of Technology DIF74 One College Ave Williamsport, PA 17701
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Please type first and last name to indicate that the information on this form is accurate and complete.