Disability Resource Checklist Form
Use this checklist to identify the disability resources, accommodations, support services, and accessibility needs that may be helpful for you.
What type of support or accommodation are you seeking?
*
Please Select
Academic
Workplace
Community/Living
Transportation
Other
Which areas of accessibility are most important to you?
*
Physical access (ramps, elevators, automatic doors)
Communication access (sign language, captioning, interpreters)
Assistive technology (screen readers, adaptive devices)
Sensory accommodations (quiet spaces, lighting adjustments)
Other
Do you require any assistive devices or technology?
Wheelchair or mobility aid
Hearing aid or listening device
Screen reader or magnifier
Speech-to-text software
Other
Do you need communication support?
*
Yes
No
If yes, what type of communication support do you need?
Sign language interpretation
Real-time captioning
Written materials in accessible formats
Other
What accommodations would help you participate fully?
*
Flexible scheduling
Alternative formats (large print, Braille)
Personal assistant or support person
Service animal access
Other
Do you have dietary or allergy-related needs?
Yes
No
Are there any transportation or parking accommodations you require?
Accessible parking
Proximity to transit
Door-to-door transportation
Other
Preferred method of contact for follow-up (if needed)
Email
Phone
Text message
Other
Please share any additional notes or specific needs not listed above.
Submit Checklist
Should be Empty: