Office for Inclusion and Civil Rights: Request an Accommodation

This form is intended to collect requests for accommodations for employees, visitors and applicants to the University of Connecticut. If you are a student seeking accommodations, please contact the Center for Students with Disabilities.

Company

This field is for validation purposes and should be left unchanged.

Accommodation Needed For:(Required)

Location of Accommodation(Required)

Other Location Description(Required)

Specific Location(Required)

Your Contact Information

Name(Required)

First Last

Role(Required)

Phone(Required)

Email(Required)

Accommodation Request

Please describe your specific issue or concern:(Required)

Please indicate any specific accommodation requests:

Please Indicate your Preferred method of follow up:(Required)

Phone

Phone (do NOT leave a message)

Email listed above

If applicable, who is your supervisor?

Your supervisor will NOT be contacted at this time.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 250 MB maximum size.

File

Max. file size: 250 MB.

Accessibility

Office for Inclusion and Civil Rights: Request an Accommodation

Your Contact Information

Accommodation Request

Supporting Documentation

Office for Inclusion and Civil Rights (Formerly, Office of Institutional Equity) - ADA / Section 504 Coordinator