*1.Full Name(Required.)

*2.Phone Number(Required.)

*3.I am requesting accommodations for:(Required.)

myself

for my guest

I am a GovState Staff/Faculty

*4.Name of Person Needing Accommodations(Required.)

*5.Accommodations Needed - Select All That Apply(Required.)

Wheelchair Accessible Seating - Choose this option if the individual has a personal wheelchair and will need to be seated in an accessible area and/or the end of a row of seats.

Wheelchair Transport to/from Seating Area - Choose this option if the individual has mobility impairments and will need a volunteer to transport them in/out of the ceremony. Please note that wheelchairs cannot remain in the seating area as volunteers are assisting several guests. Guests will be brought to/from the Main Entrance.

Visual

Seating near sign language interpreter

Seating near speakers

Sound amplifier

Other (please specify)

*6.Do you need a companion seat? Please note that only one companion seat is available for each guest needing accommodations.(Required.)

Yes

No

*7.I certify the above information to be accurate and complete. I acknowledge that the person receiving accommodations may only have one additional person accompany them in the designated accommodation areas.(Required.)

Yes, I acknowledge and understand the above statements.

*8.I understand that I am responsible for contacting ASSD at assd@govst.edu for any changes or updates to this request.(Required.)

Yes, I acknowledge and understand the above statement.