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Student Information Form

NOTE: fields marked with * are required fields

Contact Information

  • First Name*
  • Last Name*
  • Street Address*
     
  • City*
     
  • State
     
  • Zip Code*
     
  • Check if local and permanent addresses are the same.
  • Street Address
     
  • City
     
  • State
     
  • Zip Code
     
  • * Phone
     
  • Kent State Email Address*
     
  • Do you receive Vocational Rehabilitation Services through BVR or BSVI?*
    Yes    
    No    
     
  • If yes, who is your counselor?  

  • Are you a registered voter?*
    Yes    
    No    
     
  • Are you a Military Veteran?*
    Yes    
    No    
     

Student Information

  • Have you applied to Kent State University?*
    Yes    
    No    
     
  • Have you been admitted to Kent State University?*
    Yes    
    No    
     
  • Are you currently enrolled in courses?*
    Yes    
    No    
     
  • Are you a transfer student from another institution?*
    Yes    
    No    
     
  • What degree are you seeking?*
    Undergraduate    
    Graduate    
    Post-Undergraduate    
     
  • How many credit hours have you completed?*
    0-29    
    30-59    
    60-89    
    90+    
     
  • What is your major?*    

Disability Information

  • Please state the nature of your disability(ies)*
     
  • Please describe how your disability(ies) may impact your academic performance*
     
  • Please describe the accommodations you have previously used in an academic setting*
     
  • Please describe any concerns you may have*
     
  • I understand that submitting this form does not complete my registration with Student Accessibility Services*
    Yes    
     
  • I understand that in order to complete my registration with the office of Student Accessibility Services I must schedule and attend a registration appointment with an Accessibility Specialist, and provide documentation of my disability that meets Student Accessibility Services disability documentation requirements.*
    Yes