Student Support Services Application

Welcome to Oral Roberts University Student Support Services. Please complete the form below in its entirety. This will help us serve you better. 918-495-6655 - disabilityservices@oru.edu

Please Note: This application must be completed by the student.

The student named below has applied with Student Support Services at Oral Roberts University. ORU provides services and accommodations to students with disabilities. Students seeking services must provide appropriate medical documentation of their condition so that the university can determine the student’s eligibility for accommodations and, if the student is eligible, decide on the appropriate accommodations.

The Americans with Disabilities Act and Amendments (ADA-AA) defines disability as “a physical or mental impairment that substantially limits one or more major life activities, a record of such impairment, or being regarded as having such an impairment.” Disabilities involve substantial limitations and are distinct from common conditions not substantially limiting major life activities.

Documentation required to verify the student’s condition and its severity includes completion of this form and provision of equivalent information to ORU Student Support Services by a professional with the appropriate training and credentials. Quality documentation is considered to include information that:

• evidence-based
• describes the condition
• describes the functional difficulties and limitations for an educational setting
• indicates the severity and longevity of the conditions
• makes recommendations for accommodations
Select Academic Year:

Note: Select when you would like to start your services.
Term

Term Fall Fall A Fall B Spring Spring A Spring B Summer Summer A Summer B

Check all that apply.
Campus Type

Note: Select when you plan to graduate.
Expected Graduation Term:

Note: Select when you plan to graduate.
Name Name First Middle Last
Z Number (Student ID)

Please start with Z
Birth Date: Birth Date: / MM / DD YYYY

Hint: Enter the date as Month/Day/Year (example 12/31/2004)
Primary Phone Number: Primary Phone Number: - ### - ### ####
ORU Email Address

(use ORU email)
Status
All students enrolled in an institution of higher education are considered by the Department of Education as independent as it pertains to the access of their records regardless of age or status as a dependent on an individual’s tax return. If you would like for your parent(s) or another individual to have access to your records (academic and financial) please change your status to dependent. This information can be updated on vision.oru.edu.
Address Address
Street Address City State / Province / Region Postal / Zip Code
Select all Disabilities that apply.
ADHD

ADHD ADD/ADHD
Learning

Learning Central Auditory Processing Disorder Cognitive Disorder NOS Learning Disability Math Learning Disability NOS Learning Disability Reading Learning Disability Writing Neuro Developmental Disorder Speech Impediment
Medical

Medical Acquired Brain Injury Allergy (Anaphylaxis), Food Allergy, Environmental Allergy, Food Asthma Autoimmune, other Cancer Cardiovascular/Pulmonary Cerebral palsy Concussion Developmental Disability Diabetes Dystonia Ehlers Danlos syndrome (EDS) Fracture/Sprain Gastrointestinal, Immune Disorder Limited Gait or Range of Motion Long Covid Migraines Motor Neuron Oculomotor/Gaze Apraxia Optic Neuropathy Organ, Blood, Tissue Orthopedic Conditions Acute Orthopedic Conditions Chronic Osteopenia Paraplegic Postural orthostatic tachycardia syndrome (POTS) Quadriplegic Seizure Sleep Disorder Spine/Spinal Injury Surgery Tourettes
Mental Health

Mental Health Adjustment Disorder Anxiety Disorders Bi Polar Depression Eating Disorders Misophonia Obsessive Compulsive Disorder Oppositional Defiant Disorder Panic Disorder Post Traumatic Stress Disorder Schizophrenia, Personality Disorders
Sensory

Sensory Blind Deaf Hard of Hearing Visual Impairment
Spectrum

Spectrum Autism Spectrum Disorder
Other Disability or Note:
Classification

Classification Graduate Student Undergraduate Student
Additional Note:
Please check all the accommodations you are requesting at ORU.
Alternative Testing

Alternative Testing Breaks Not Counted in Testing Time Calculator Computer (without Internet to type exam responses) Extended Time on Tests Large Print Exams (14-point font) Low Light Testing Environment Permission to Mark Directly on Exam/No Answer or Bubble Sheets Permission to take written test instead of computer test, if possible Reduced Distraction Environment Reschedule Tests Speech-to-Text Program for Tests Spelling/Grammar Check Text-to-Speech program for Tests
Alternative Formats

Alternative Formats Audio Description Videos Braille Large Print Materials (text and graphics)
Deaf and Hard of Hearing

Deaf and Hard of Hearing Assistive Listening Devices Closed Captioned Videos Interpreting Real Time Captioning
Notetaking Services

Notetaking Services Peer Notetaker
Classroom Access

Classroom Access Food/Drink in Class Permission to Leave Class Preferential Seating Remote Learning Wheelchair Accessible Desk/Table
Housing Accommodations

Housing Accommodations Access to kitchen ADA Equipped Bathroom Animal/Environmental Allergy Braille Signage Centrally Located First Floor or Elevator Access Low Traffic Area No Bunk Beds Private Room (when available) Service Animal Emotional Support Animal Visual Fire Alert in Room Wheelchair Accessible Space Registered Dietary Consult
Parking and Transportation Accommodations

Parking and Transportation Accommodations Handicapped Parking
Please describe any relevant aspects of this condition (i.e. substantial functional limitations) that may impact educational or interpersonal behavior and achievement.
Please describe any medication side-effects that may impact academic performance.
Please identify the specific dietary restrictions and/or specific recommendations.
4. How did you hear about ORU Student Support Services?

4. How did you hear about ORU Student Support Services? Academic Advisor Family Member Instructor Counseling Center Student Health Center Friend Other (Please specify below)
Additional Note or Comment
Upload Corresponding Medical Documentation Here:

Academic Accommodations - Acceptable documentation that verifies your diagnosis or disability includes a copy of your high school IEP or 504 plan, psychoeducational evaluation, or letter (on letterhead with signature) from your licensed healthcare provider. If your documentation is deemed insufficient, you will be asked to submit additional documentation.

Non- Academic Accommodations – Please submit applicable Disability Verification Form (Housing, ESA/Service Dog, Dining, or HPE).

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Student Support Services Application

Student Support Services Application

Select all Disabilities that apply.

Please check all the accommodations you are requesting at ORU.