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Accessibility Request Form Fine Arts
If you need assistance in completing this form or an alternate format of the form, please contact the Fine Arts Office at (507) 933-7013 or
msousa@gustavus.edu
.
To download an accessibility map, refer to
https://gustavus.edu/about/files/accessibility_map.pdf
. The college does not provide loaner wheelchairs, scooters, or other personal mobility devices.
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* Indicates required question
Contact Information for the person in need of accommodation
First Name
*
Your answer
Last Name
*
Your answer
Designation
*
Choose
Current Student
College Guest or Former Student
Staff/ Faculty
Cell Phone
*
Your answer
Email
*
Your answer
Preferred way to contact
*
Email
Phone
Event Name
*
Your answer
Event Date
*
MM
/
DD
/
YYYY
Event Starting Time
*
Time
:
AM
PM
Event Location
Your answer
I will request the following accommodations in order to participate:
*
Assistive listening device (available in Anderson Theatre, Gardner Lab Theatre, Chapel, and Bjorling)
Reserved special seating
Advance copy of programs available on event website
Wheelchair access
Other:
Required
Dietary Restrictions:
Your answer
Other:
Your answer
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