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Campus Accessibility Request Form

To request accessibility to a campus-sponsored event, please complete the form as fully as possible and submit it at least 5 business days prior to the event.

You will receive confirmation that your request has been received. If you have any questions, please e-mail Karen.Boyd@colorado.edu or call (720) 210-5827.

Requester name
Requester phone - -
Requester e-mail
Requester title
 
ACCOMMODATION REQUESTED (check all that apply)
Materials in Alternate Format
Braille
  Electronic Format
     PDF    
     Word    
     Other    
 
Communication Access
Interpreting
Real-time captioning
  FM System
     Personal  
     Group (link)  
 
Physical Access (please refer to the Campus Accessibility Guide at www.colorado.edu/disabilityservices/accessguide.html)
  Please describe:
 
EVENT
Date(s) Day of the Week Time: from - to
to
to
to
to
Type of Event (meeting, conference, lecture, etc.)
Event Location
Special Notes (agenda, meeting outline, guest speakers, etc.)
Event sponsor/department
Event contact person
Event contact phone (include area code) - -
Event contact e-mail
 
PARTICIPANT(S)
#1
#2
#3
 

PAYMENT: Only for revenue-generating events.

The cost for accessibility requests will be charged to a Speed Type and PeopleSoft number and we will mail a copy of the transaction to the account contact person for account reconciliation.

If you have any questions as to whether your event will qualify for campus access funds, please review the CAF guidelines.

 
Account contact
E-mail address
Phone number - -
Department
Campus box number
 
FOR OFFICE USE ONLY
NON-BILLABLE (Campus sponsored event; Non-revenue generating event)
BILLABLE (Non-campus sponsored event; Revenue generating event)
Speed Type
PeopleSoft account # (such as 552605)
 

Revised 2/12

     
University of Colorado at Boulder


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