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Equal Opportunity Office
Equal Opportunity Office Home

Request for Service

 

*First Name
Middle Name or Initial
*Last Name
*Phone Number
Address
City
State
Zip
*Email
I believe that I qualify for services offered by Equal Opportunity/Disability Services
  Yes No
I believe that I would benefit from services offered by Student Counseling and Educational Support Services
  Yes No
I have used similar services (e.g. extended test time, separate testing location, etc.) in the past (high school, college).
  Yes No
I plan on contacting Equal Opportunity/Disability Services when I am involved in my program at KUMC.  
  Yes No
I plan on contacting Counseling and Educational Support Services when I am involved in my program at KUMC.
  Yes No
I wish to be contacted by (check all that apply)
Equal Opportunity/Disability Services  
Counseling and Educational Support Services
   
 

Questions? Email Equal Opportunity Office: Carol Wagner .