Intake Request Form

* indicates a required field

Student Information

Instructions: Complete the form to the best of your ability. Required(*) fields must be filled out for the form to submit. Please provide your KSU-issued email address as this is the primary method that Student Disability Services will contact students after review of the Intake Form.

First Name

Last Name

Middle Name

Preferred Name

KSU ID Number

Please enter your 9 digit KSU ID Number

Please use your KSU issued email address

Phone Number

Primary Campus Location

Major

Are you a veteran?

Are you a Vocational Rehabilitation Agency client?

Accessibility Specific Information

Instructions: Please fill in as much information as you are able. Required (*) fields must be completed for the form to submit.

What is/are your specific disability/disabilities

When was your disability first diagnosed?

Do you have any documentation of your disability?

Are you currently taking any medications related to your disability?

How does your disability affect you academically?

How does your disability affect student life in general?

Please list the accommodations you are requesting.

Upload supporting document(s)

Please upload your documentation here. If you have difficulties, you can also email it to Student Disability Services office at sds@kennesaw.edu or submit it via fax or mail. (View the "Contact Us' page for mailing and fax information on our website.)

Intake Request Form

Student Information

Accessibility Specific Information

Document Information