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Accessibility Request Form
If you need assistance in completing this form or an alternate format of the form, please contact the Office of Marketing and Communication at (507) 933-7520 or
marketing@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
Staff / Faculty
Prospective student or family
Other such as alumni, former employee, family of current student
Cell Phone
*
Your answer
Email
*
Your answer
Preferred way to contact
Choose
Text
Phone
Email
Event Information
Event Name
Your answer
Event Date
MM
/
DD
/
YYYY
Event Start 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)
Reserved special seating
Advance copy of slides to be projected available on event website
Advance copy of programs available on event website
Wheelchair access
Lactation room
Gender neutral bathroom
Other:
Dietary Restrictions:
Your answer
Other:
Your answer
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