Public Accommodation Request

Please complete the following form. There is an option at the bottom of the form FOR STUDENTS ONLY to upload supporting documentation. Employees, visitors, or external applicants are not supposed to submit documentation to DMS; ONLY STUDENTS. If you are a student and do not have documentation, please ask your medical provider to submit supporting documentation directly to the SDAO. Please share the appropriate documentation guidelines found on our website with your medical provider.
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Student/Current & External Employee/Visitor Information

Please enter your information

*Students: please enter UNIQUE ID - NOT Student ID

*Current Employees: enter Unique ID

*New External Applicants: Please enter phone number without dashes

*Visitors: Please enter phone number without dashes

Ex: xxx-xxx-xxxx

 

Students:please use your university issued email address

Employees: please use your preferred email address

Accommodation Request Information

Instructions: Below, you will find descriptions of the various types of disabilities recognized in the United States. Please select the category of your disability that best represents the nature of your medical condition.

RELEASE/EXCHANGE OF INFORMATION

Fire/Safety Evacuation

We ask that all employees and students identify any medical limitations that may limit their ability to effectively and safely evacuate during an emergency situation. We collect this information to assist our office in developing an emergency evacuation plan in conjunction with the University. Self-identification is voluntary, and the information you provide will be kept confidential and only shared with those individuals who have responsibilities in facilitating the emergency evacuation plan. If additional information is needed, we will contact you as soon as possible.  The Disability Management System representative will forward the completed form to the Occupational and Environmental Safety Office (OESO) Fire Safety Division, 1411 Hull St. Box 90427, Fax 919-684-5487.