2024-25 ADA Housing Accommodations Registration Form

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2024-25 ADA Housing Accommodations Registration Form

Please complete the information below and a Disability Services staff member will contact you. In order to receive accommodations through JSU Disability Services, you must provide documentation that specifies your disability.

Email *

I. J-Number *

II. Gender: *

Male

Female

Choose not to answer

III. Ethnicity: *

White

Black or African-American

Asian

Native Hawaiian or other Pacific Islander

Multiple races

Choose not to answer

IV. Name (First Name, Middle Initial, Last Name) *

V. Age *

19 or younger

20-23

24-29

30-39

40-55

Over 55

VI. Contact Number *

VII. Home Address (include City, State, Zip) *

VIII. Local Address (if applicable)

IX. Are you a first generation college student?

Yes

Clear selection

X. Veteran Status

Veteran

Veteran-Dependent

Non-Veteran

Choose not to Answer

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