Adaptive Furniture Request Form - You will need to complete one form per course.

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This form allows students who are approved for adaptive furniture placement accommodations to make a furniture placement requests when needed.

Many classes have been set up with Universal Design in mind, and adaptive furniture is already in the classroom. In these cases, an Adaptive Furniture Request Form is not required.

It is critical that you visit the classroom prior to completing this Adaptive Furniture Request Form, as you may need to be familiar with the classroom set up to make the appropriate request. You may view classroom floor plans at http://classrooms.ucr.edu/. If additional information is needed, you will be contacted.

Please note that it takes up to 5 business days to fulfill an Adaptive Furniture placement request. If at any time, the Adaptive Furniture has been removed, or the accommodation need changes, please contact SDRC and schedule a meeting with a Disability Specialist to discuss accommodation needs by calling (951) 827-3861.

If you have not yet been approved for the request being made, please contact SDRC and schedule a meeting with a Disability Specialist to discuss your request.

First Name *

Last Name *

UCR Email *

Student ID number *

Course & Section (example: BUS 119 section 001) *

When is your first day of class? *

YYYY

When is the last day of class? *

YYYY

Days of the week the class meets? (Please specify days) *

Monday, Wednesdays, Fridays

Tuesdays, Thursdays

Monday through Friday

Saturdays

Other:

At what time does the class start? *

Time

Building? *

Floor?

Classroom Number *

Based on the classroom space, please identify your preference for the adaptive furniture placement (if applicable). *

Front of the classroom

Back of the classroom

No preference

Please identify the approved furniture accommodation you are requesting. *

Chair without armrests

Chair with armrests

Wheelchair accessible table (standard height range)

Standard Height table

Left handed desk

Other:

Special notes on requested furniture

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