Online Student Application

Personal Information

Start Term *:
Note: Select when you would like to start your services.
Expected Graduation Term:
Note: Select when you plan to graduate.
First Name *:
Last Name *:
Middle Name:
Optional: Preferred Name:
Student ID:
Hint: Enter 9 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Pronouns:

Contact Information

Local Address

Permanent Address

Same as Local Address

Additional Information

Prior Accommodations

What accommodations are you requesting that were not listed above?
Share how your diagnosed disability/medical condition is impacting/will impact you at OSU in relation to the accommodations you have requested. Consider skills: reading, writing, paying attention, mathematics, etc. Describe the current impact in the following areas: (1) In Class: lectures, labs, exams, presentations, group work, attendance, etc; (2) Other areas that may be impacted on campus.

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Oregon State University
A200 Kerr Administration Building
Corvallis, OR 97331

Website: http://ds.oregonstate.edu
Email Us: Disability.Services@oregonstate.edu

Phone: (541) 737 - 4098
Fax: (541) 737 - 7354