Adults with Disabilities Enrollment Request Form

This form is used for new students that wish to enroll in the Adults with Disabilities Program at F.K. Marchman Technical College.

If you previously attended Adults with Disabilities classes at F.K. Marchman Technical College and wish to re-enroll, please reach out to Ms. Taylor at 727-774-1700.

Applicant Name: Applicant Name: First Last
Name of Person Completing Form: Name of Person Completing Form: First Last
Date of Birth: Date of Birth: / MM / DD YYYY
Pasco Student Number: (If previous Pasco County Student)
Phone Phone - ### - ### ####
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
List all schools attended in the last 5 years (If none, enter N/A):
List all Exceptionalities:
Discuss the needs of the student:
Individual Education Plan (IEP) - If available, please upload the most recent IEP.

Attach Files
By signing below, I confirm that I have read and understand the requirements for enrollment into the Adults with Disabilities Program. Copy and paste this web address to review: https://mtec.pasco.k12.fl.us/age-awd/

By signing below, I confirm that I have read and understand the requirements for enrollment into the Adults with Disabilities Program. Copy and paste this web address to review: https://mtec.pasco.k12.fl.us/age-awd/ I understand
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