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Online Student Application

Two easy steps to register
Please provide all information relevant to your request for accommodations at A-State.
A place will be provided in Step #2 for you to securely upload any documentation you have that supports your eligibility for services. Note: your application will be fully processed when you have been admitted and have a class schedule. Once you have a class schedule, please schedule an intake appointment with our office.
If you are scanning your document use 150 - 300 dpi as the resolution and the maximum allowable file size is 1 MB per upload. Large files may need to be broken down into smaller files. If you do not want to use this feature you may drop your documentation off at our office or fax to 870-972-3351.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  3. Hint: Enter 8 alpha numeric characters.
  4. Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Contact Information
  1. Hint: Enter 10-digit number only.
  2. Hint: Enter 10-digit number only.
Local Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  1. Secondary Disability(ies)

    ADD/ADHD

    Autism Spectrum

    Cognitive

    General Category

    Health Condition

    Hearing Impaired

    Learning Disability

    Muscular

    Musculoskeletal

    Neurological

    Neuromuscular

    No Disability

    Physical Dexterity

    Physical Mobility

    Psychiartric/Psychological

    Pulmonary

    Speech Impaired

    Visually Impaired

  2. Affiliation(s)
  3. Ethnicity(ies)
  4. Campus Location(s)
Please select services you are SEEKING to request with our office, and provide documentation for your eligibility

Requesting Accommodations at AAS

Alternative Testing
Alternative Formats
Deaf and Hard of Hearing
Others
Notetaking Services
Classroom Access/Accommodations
Questions
  1. What brings you to Disability Services
  2. Current educational classification *
  3. Do you use a wheelchair or other mobility device? *
  4. Do you have seizures? *
  5. Do you have a health condition that requires the university to have special instructions or prior knowledge of condition? *
  6. Do you take medications that may influence your academics? *

Release of Information Form

I give permission for relevant records to be released to Arkansas State University's Access and Accommodation Services for the purpose of facilitating reasonable accommodations due to a disability/impairment. Relevant records may include but are not limited to:

  • Documentation of disability from healthcare professional
  • Psychological or vocational assessment and treatment
  • Educational Information
  • Medical Information

This release is valid throughout the individual's educational experience at A-State unless revoked by the individual with a disability (or parent/guardian if student is under the age of 18). I understand that I may revoke this consent to release information at any time; however, I also understand that any release made prior to revocation and which was made based on this authorization, does not constitute a breach of my right to confidentiality.

Grievance Procedure:

Grievance is defined as a formal verbal or written expression of dissatisfaction with some aspect of services that have not been resolved to the student’s satisfaction at the point of service. All verbal or written complaints should be sent to Access and Accommodation Services director. Grievances will be reviewed by appropriate parties and responded to within 4 weeks. If the grieved party is unsatisfied with the outcome of the grievance procedure, an appeal may be submitted to the Access and Accommodation Services Committee.

By clicking the following button, "Submit Application", you have agreed to the above terms and conditions regarding Release of Information. You will receive a copy of this statement in an email.

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