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Creating a Better World for the Physically Impaired

Note: Currently all classes at the Nellie Sherk Amputee Activity Center are on hold until relocation is completed to new facilities. All off-site training will continue without interruption.

ADAPTING is a nonprofit corporation under Section 501c3 of the Internal Revenue Code of the United States..

One of ADAPTING'S primary functions is to train qualified disabled people in hi-tech job disciplines such as website design, multimedia authoring, desktop publishing, graphic design, and related topics for the purpose of removing disabled individuals from social security disability or welfare and restoring them to an income producing, tax generating job opportunity.

Verification of qualified status must be completed prior to enrollment.

It is the policy of ADAPTING not to discriminate against any individual on the basis of race, color, religion, national origin, sex, sexual orientation,marital status, age, disability, or veteran status in matters of admissions, employment, housing, or services or in the educational programs or activities it operates, in accordance with civil rights laws or regulations.

Application For Enrollment Please Print or Type:

Please complete this form and mail to the address shown below.

Name: (Last)_______________________ (First) _____________ (MI) ____

Address: _____________________________________________Apt:_____

City: ______________________________ State: _____Zip Code: ________

Telephone: (Including Area Code)__________________________________

Reference Person: Name (Last) _______________________ (First) _______

Relationship: ______________________ Telephone: ___________________

Address: ______________State: _____ Zip Code: _________

To Be Completed By Certifying Authority:

I certify that the applicant named above has the following disability and that he or she is either on welfare or social security disability income and, is able and capable to understand and complete the vocational training offered at ADAPTINGas required to complete instruction at the ADAPTING vocational facility.

Type of Disability (To be completed by the Primary Care Physician):________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

Name: _______________________________ Title: _____Date: ________

Company: __________________________________________________

Address: ________________________________________Suite: _______

City: _________________________________ State: __Zip Code: _______

Telephone: _____________________________

email: _______________ Verified By: ________________________________Date: _____________

Board Review: ______________________________Date: _____________

Comments:__________________________________________________

Mail Application to: ADAPTING Application Dept. POB 5553 Beaverton, OR 97006

Telephone: 503 330-0352