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Request for Accommodations Form

Request for Accommodation through Student Disability Services.

Please fill in all blanks. Place "n/a" in blanks that do not apply.

Documentation Submission Status

I have submitted documentation
I have not yet submitted documentation

Personal Information

First Name
Last Name
KSU ID Number

Academic Information

Kennesaw Campus
Marietta Campus


Previous College

Disability Information

Attention Deficit Hyperactivity Disorder (ADHD)
Brain Injury
Chronic Health Condition
Deaf/Hard of Hearing
Learning Disability
Mobility Impairment
Psychological Condition
Visual Disability
Autism Spectrum

If other, please list disability here

Please describe the impact of your disability in an academic environment


What accomodations have you used previously (If any)?

High School:

Previous Colleges:

List the accomodations you are requesting (Testing accomodations, notetakers, etc...):

Contact Student Disability Services at sds@kennesaw.edu with any problems or concerns.



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