Online Student Application

By completing this Application you are requesting for the review of potential accommodations at The University of Akron.

By submitting the application listed below, you agree to the following:

I understand that admission to The University of Akron is a separate process.
I understand I must submit documentation of my disability prior to meeting with a specialist for an intake appointment.
I authorize the Office of Accessibility to contact my physician to clarify any questions regarding my documentation.
I understand that submitting this form does not automatically qualify me for accommodations and/or services.
I understand I will not be eligible to receive services until all documentation is provided.

Personal Information

Start Term *:
Note: Select when you would like to start your services.
Primary Campus *:
Note: Please select campus location where you will be enrolled.
Expected Graduation Term:
Note: Select when you plan to graduate.
First Name *:
Last Name *:
Middle Name:
Optional: Preferred Name:
Student ID:
Hint: Enter 7 alpha numeric characters.
Birth Date *:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Gender *:

Contact Information

Cell Phone Number:
Hint: Enter 10-digit number only.
Land Line Phone Number:
Hint: Enter 10-digit number only.
Email Address *:

Local Address

Address *:
City *:
State *:
Zipcode *:
Hint: Enter zipcode as 97331 or 97331-0000.

Permanent Address Same as Local Address

Address:
City:
State:
Zipcode:
Hint: Enter zipcode as 97331 or 97331-0000.

Additional Information

Ethnicity(ies)

African American

Asian American

Biracial

Caucasian

Hispanic

International

Native American

Other
Additional Note:

Questions

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