Campus Vending Machine Accommodation Request Form
Submit your request for accommodations related to campus vending machine access or use. Please provide detailed information to help us address your needs efficiently.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Campus Location
*
Please Select
Main Campus
North Campus
South Campus
East Campus
West Campus
Other
Vending Machine Location or ID
*
Type of Accommodation Needed
*
Please Select
Physical Access Adjustment
Extended Access Hours
Alternative Payment Method
Assistance with Use
Other
Preferred Access Method
Card Access
Mobile App
Physical Key
Staff Assistance
Other
Requested Timing for Accommodation
-
Month
-
Day
Year
Date
Urgency Level
*
Immediate
Within a week
No rush
Additional Notes or Supporting Information
Upload Supporting Document (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Request
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