Student Accommodation Request

Student Information

Completing this online intake form is the first step in the accommodations process for students at Keene State (Register with ODS, Submit Documentation, Meet with ODS). This form should only be completed by Keene State students.

Please complete the online intake form to the best of your ability. It is important to complete all fields. Once you have completed the form, you will be sent additional information about how to submit documentation.

If you have questions at any time, please contact the ODS office at kscdisabilityservices@keene.edu.

First Name

Last Name

Middle Name

Student ID

Keene State Email

Please use your college issued email address

Phone Number

Pronouns

Are you a transfer student?

Are you a veteran?

Are you working with Vocational Rehabiliation?

Are you a Keene State student athlete?

Are you part of the ASPIRE Program?

Disability Information

Please describe your disability and how it impacts learning and living

Please specify condition(s)

Is your disability temporary?

Accommodation Information

What specific accommodations are you requesting?

What accommodations have you had in the past? How were these helpful?

Is there anything else you would like us to know about at this point?

Upload supporting document(s)

For more information on documentation requirements, please visit our website.

Student Accommodation Request

Student Information

Disability Information

Accommodation Information

Document Information