Accommodations Request Form

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Please complete this form 2-3 weeks in advance of the class or event for which you need accommodation. Loft staff will reach out to follow up on any requests if necessary!

Email *

How would you prefer we contact you? *

phone

Phone number

Preferred Name - First and Last *

What class, event, or other Loft opportunity are you requesting this accommodation for? (Please include the date(s) of the event/class.) *

What is your accommodation request? *

Large print materials

Materials adapted to work with screen readers

Braille materials

Sound amplification

Assistive listening device connected to hearing aids (t-coil)

Use of bluetooth to connect to hearing aids

ASL interpretation

Captioning

Front row or preferential seating (near door, near speaker, etc)

Seating space for personal attendant

Class instructions for inclusion of trained service animal

Severe allergy accomodations (Fragrance, Peanut, etc)

Chair w/o wheels

Other:

Required

Is there anything else you'd like to request or tell us about your accommodation needs?

Submit

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