Office of Student Accessibility Registration

Office of Student Accessibility Registration
Name:*

First NameLast Name
Student ID number:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
Type of Accommodation:

PhysicalLearningMental HealthTemporary
Are you a returning student?

YesNo
Term applying for:

FallSpringSummer
Year:
Are these changes to already existing paperwork?

YesNo
Please describe any specific accommodation you may request that are not outlined in your supporting documentation:
Additional comments:
Attach documentation (If multiple files, please ZIP and upload)

Browse Files

Cancelof
Email the Office of Student Accessibility Registration or call 859-344-3541 if you have additional questions.
Should be Empty: