ADA Furniture Request Form

This form is intended only for use by students already registered with the Access Center. This form needs to be submited each semester you are requesting accommodations.

 

Name:
Student I.D.#:
Metro E-mail:
Disability Coordinator:
Semester Requesting Accommodation:
Type of Chair:
Type of Desk:
Building Name and Room#:
Building Name and Room#:
Building Name and Room#:
Building Name and Room#:
Building Name and Room#:
Building Name and Room#:
Additional Information:

If you have any questions or concerns regarding your special furniture request please contact Jennie Stoutenburg at 303-556-8387.