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. 

Please enter your 9 digit KSU ID Number
Please use your KSU issued email address
Are you a veteran?Required
Are you a Vocational Rehabilitation Agency client?Required

Accessibility Specific Information

Instructions: Please fill in as much information as you are able. Required (*) fields must be completed for the form to submit.
Do you have any documentation of your disability?
Are you currently taking any medications related to your disability?
Upload supporting document(s)

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