Accessibility Needs Survey for Reasonable Accommodations

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1. What specific accessibility needs do you have?

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2. Which of the following accommodations would be helpful for you? (Select all that apply)

Sign language interpreter

Earplugs

Assistive listening devices

Large print materials

Cooling towels/fans

Braille handouts

Remote/streaming option

Sensory items (fidgets, sunglasses, etc.)

Other (please specify)

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3. Would you like to be contacted for further discussion about your accessibility needs?

Yes

No

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4. Please provide your name (optional).

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5. Please provide your email address (optional).

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6. Please provide your phone number (optional).