Online Student Application

1. Start Term *: Select One 2021 - Summer 2021 - Fall 2022 - Spring 2022 - Summer 2022 - Fall 2023 - Spring 2023 - Summer 2023 - Fall 2024 - Spring 2024 - Summer 2024 - Fall 2025 - Spring 2025 - Summer 2025 - Fall 2026 - Spring 2026 - Summer 2026 - Fall 2027 - Spring 2027 - Summer 2027 - Fall 2028 - Spring 2028 - Summer 2028 - Fall 2029 - Spring 2029 - Summer 2029 - Fall 2030 - Spring 2030 - Summer 2030 - Fall 2031 - Spring 2031 - Summer 2031 - Fall 2032 - Spring 2032 - Summer 2032 - Fall 2033 - Spring 2033 - Summer 2033 - Fall 2034 - Spring 2034 - Summer 2034 - Fall 2035 - Spring 2035 - Summer 2035 - Fall 2036 - Spring 2036 - Summer 2036 - Fall 2037 - Spring 2037 - Summer 2037 - Fall 2038 - Spring 2038 - Summer 2038 - Fall 2039 - Spring 2039 - Summer 2039 - Fall 2040 - Spring 2040 - Summer 2040 - Fall 2041 - Spring 2041 - Summer 2041 - Fall 2042 - Spring 2042 - Summer 2042 - Fall 2043 - Spring 2043 - Summer 2043 - Fall 2044 - Spring 2044 - Summer 2044 - Fall 2045 - Spring 2045 - Summer 2045 - Fall 2046 - Spring 2046 - Summer 2046 - Fall 2047 - Spring 2047 - Summer 2047 - Fall 2048 - Spring 2048 - Summer 2048 - Fall 2049 - Spring 2049 - Summer 2049 - Fall 2050 - Spring 2050 - Summer 2050 - Fall
   Note: Select when you would like to start your services.
2. Primary Campus *: Select One College of Veterinary Medicine DVM Global Campus Great Plains IDEA Manhattan Main Campus Olathe Campus Polytechnic Campus Polytechnic Online Campus
   Note: Please select campus location where you will be enrolled.
3. Expected Graduation Term: Select One 2015 - Spring 2015 - Summer 2015 - Fall 2016 - Spring 2016 - Summer 2016 - Fall 2017 - Spring 2017 - Summer 2017 - Fall 2018 - Spring 2018 - Summer 2018 - Fall 2019 - Spring 2019 - Summer 2019 - Fall 2020 - Spring 2020 - Summer 2020 - Fall 2021 - Spring 2021 - Summer 2021 - Fall 2022 - Spring 2022 - Summer 2022 - Fall 2023 - Spring 2023 - Summer 2023 - Fall 2024 - Spring 2024 - Summer 2024 - Fall 2025 - Spring 2025 - Summer 2025 - Fall 2026 - Spring 2026 - Summer 2026 - Fall 2027 - Spring 2027 - Summer 2027 - Fall 2028 - Spring 2028 - Summer 2028 - Fall 2029 - Spring 2029 - Summer 2029 - Fall 2030 - Spring 2030 - Summer 2030 - Fall 2031 - Spring 2031 - Summer 2031 - Fall 2032 - Spring 2032 - Summer 2032 - Fall 2033 - Spring 2033 - Summer 2033 - Fall 2034 - Spring 2034 - Summer 2034 - Fall 2035 - Spring 2035 - Summer 2035 - Fall 2036 - Spring 2036 - Summer 2036 - Fall 2037 - Spring 2037 - Summer 2037 - Fall 2038 - Spring 2038 - Summer 2038 - Fall 2039 - Spring 2039 - Summer 2039 - Fall 2040 - Spring 2040 - Summer 2040 - Fall 2041 - Spring 2041 - Summer 2041 - Fall 2042 - Spring 2042 - Summer 2042 - Fall 2043 - Spring 2043 - Summer 2043 - Fall 2044 - Spring 2044 - Summer 2044 - Fall 2045 - Spring 2045 - Summer 2045 - Fall 2046 - Spring 2046 - Summer 2046 - Fall 2047 - Spring 2047 - Summer 2047 - Fall 2048 - Spring 2048 - Summer 2048 - Fall 2049 - Spring 2049 - Summer 2049 - Fall 2050 - Spring 2050 - Summer 2050 - Fall
   Note: Select when you plan to graduate.
4. First Name *:
5. Last Name *:
6. Middle Name:
7. Optional: Preferred Name:
8. Student ID:
   Hint: Enter 9 alpha numeric characters.
9. Birth Date:
   Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
10. Gender *: Select One Female Male Other/Not Specified
11. Pronouns: Select One he, him, his, himself she, her, hers, herself they, them, their, theirs, themself

1. Primary Phone Number:
   Hint: Enter 10-digit number only.
2. Secondary Phone Number:
   Hint: Enter 10-digit number only.
3. Email Address *:
   Hint: If you have a K-State email address, please input that address.

1. Address *:
2. City *:
3. State *: Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Wyoming International
4. Zipcode *:
   Hint: Enter zipcode as 97331 or 97331-0000.

Same as Local Address

1. Address:
2. City:
3. State: Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Wyoming International
4. Zipcode:
   Hint: Enter zipcode as 97331 or 97331-0000.

1. Primary Disability *: Select One === ADHD === ADD/ADHD === Autism Spectrum Disorder === Autism Spectrum Disorder/Asperger Syndrome === Brain Injury === Acquired Brain Injury (ABI) Post-concussion Syndrome Traumatic Brain Injury (TBI) === Chronic Health Impairment === Chronic Health Impairment Seizure Disorder === Deaf Blind === Deaf Blind === Deaf/Hard of Hearing === Deaf Hard of Hearing === General Category === Other Temporary Disability === Learning Disability === Learning Disability === Mental Health === Mental Health Diagnosis === Mobility Impairment === Mobility Impairment === Neurodevelopmental === Central Auditory Processing Disorder Communication Disorders Intellectual Disability Other Neurodevelopmental Tic Disorder Tourette's Syndrome === Severe Allergy === Contact Allergy Diet Related Allergy/Intolerance === Speech/Language Impairment === Speech/Language Impairment === Visual Impairment === Blind Visual Impairment
2. Secondary Disability(ies)

   ADHD

   ADD/ADHD

   Autism Spectrum Disorder

   Autism Spectrum Disorder/Asperger Syndrome

   Brain Injury

   Acquired Brain Injury (ABI)

   Post-concussion Syndrome

   Traumatic Brain Injury (TBI)

   Chronic Health Impairment

   Chronic Health Impairment

   Seizure Disorder

   Deaf Blind

   Deaf Blind

   Deaf/Hard of Hearing

   Deaf

   Hard of Hearing

   General Category

   Other

   Temporary Disability

   Learning Disability

   Learning Disability

   Mental Health

   Mental Health Diagnosis

   Mobility Impairment

   Mobility Impairment

   Neurodevelopmental

   Central Auditory Processing Disorder

   Communication Disorders

   Intellectual Disability

   Other Neurodevelopmental

   Tic Disorder

   Tourette's Syndrome

   Severe Allergy

   Contact Allergy

   Diet Related Allergy/Intolerance

   Speech/Language Impairment

   Speech/Language Impairment

   Visual Impairment

   Blind

   Visual Impairment
3. Other Disability or Note:
4. Seeking Degree: Select One Associates Degree Bachelors Degree Certificate Doctor of Veterinary Medicine Masters Degree Minor Ph.D. Degree Post Baccalaureate

Affiliation(s)

5. Affiliation(s)

   First Generation

   Interested in Career Information

   Student Athlete

   TRiO/ESS

   Veteran

   Vocational Rehabilitation

Ethnicity(ies)

6. Ethnicity(ies)

   American Indian or Alaska Native

   Asian

   Black or African American

   Hispanic or Latino

   Native Hawaiian or Other Pacific Islander

   Other/Not Reported

   White
7. Additional Note:

1. What prior accommodations, if any, have you utilized? *
2. How did you hear about disability services?

   Family Member

   Academic Advisor

   Instructor

   Counseling Services

   Lafene Health Center

   Other (Specify Below)

   Additional Note or Comment