OSA New Student Application

Student Information

Please enter your information

First Name

Last Name

Date of Birth

Student ID Number

In order to apply for accommodations you should first be admitted to NKU and have been issued a 9-digit Student ID

Email

Please use your university issued email address

Cell Phone Number

Current student status

Are you registered to vote?

Specific Accommodation Information

Did you receive support services or other accommodations in high school, or another university

What accommodations/services are you requesting:

Primary Disability Category

Documentation

If you do not have documentation, please contact our office at 859-572-5282 or osa@nku.edu

Upload supporting document(s)

If you do not have documentation, please contact our office:

Phone Number: 859-572-5282

Email: osa@nku.edu

Consent

By signing this form, I am signifying my consent for the review of my request for accommodations. I understand that the Office for Student Accessibility (OSA) will not provide/approve accommodations or services until the interactive intake process has been completed with an OSA staff member. I understand the Office for Student Accessibility staff will not disclose my records to others unless I give permission for them to do so or unless the law authorizes or compels them to do so. By signing this form, I agree that the above information is true and accurate. OSA will reach out within 3-5 business days. I understand that if I do not reply to OSA correspondence within 60 days, my application and documentation will be deleted from the portal.

Electronic Signature

Please type your full name here and input today’s date below.

Today's Date