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Online Student Application

Two easy steps to register
As a student of the University of North Texas Health Science Center (UNT Health Science Center) and an individual claiming to have a permanent disability (hereinafter referred to as “disability”), I hereby designate the Office of Disability Access (ODA) to be the holder of record for documentation of my disability and request that accommodations which are appropriate to my disability, and reasonable in the context of the academic and student service environment under the American with Disabilities Act (ADA), be provided to me by applicable entities at the UNT Health Science Center. This form is intended to be used in gathering information and in conjunction with required documentation. Completing this form does not guarantee accommodations and will not be considered if documentation is not submitted.
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)

    Cognitive

    General Category

    Physical/Systemic

    Psychological

    Sensory

  2. Affiliation(s)
  3. Ethnicity(ies)
  4. Campus Location(s)
If applicable, please check all accommodations you have used in the past. If there are additional accommodations you have used but are not listed, please enter those in question #7 below.

Prior Accommodations

Alternative Testing
Alternative Formats
Deaf and Hard of Hearing
Others
Classroom Access
Surrogate Accommodations
Please check all accommodations below that you would like to request. If there are additional accommodations you would like to request, please list those in question #8 below.

Requesting Accommodations at ODA

Alternative Testing
Alternative Formats
Deaf and Hard of Hearing
Others
Classroom Access
Surrogate Accommodations
Questions
  1.  
    What is your current student status? * (Selection is Required)
  2.  
    How did you hear about this office?
  3.  
    If you are currently enrolled and struggling in your classes please indicate if any of the following apply.
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