Please complete this form with a detailed description of where and what type of campus access problem you are experiencing or have witnessed. We may need to contact you regarding your issue to better understand the concern so be sure to include contact information. If you require assistive technology or other assistance in completing this form, please contact the ADA Compliance Office.  Thank you!

Name:

I am a: - Student Member of the general public Faculty Staff

If Faculty or Staff, please include Title and Dept:

Title:

Department:

Email:

Phone:( ###-###-####, preferred contact no.)  

How do you prefer to be contacted?

E-mail Phone  Other:

If applicable, select location where access problem occurred:   - 4th Street Parking Garages 10th Street Parking Garages 7th Street Parking Garages Administration Aquatics Facility Art Building Associated Students House Automated Teller Machines Boccardo Business Center Building BB Building Q Business Tower Cafeteria Campus Village A Campus Village B Campus Village C Career Center Central Classroom Building Clark Hall Computer Center Concert Hall Corporation Yard Dining Commons Dr. Martin Luther King, Jr. Library Dudley Moorhead Hall Duncan Hall Dwight Bentel Hall Engineering Building Event Center Faculty Offices Health Building Heating & Cooling Plant Hoover Hall Hugh Gillis Hall Industrial Studies Instructional Resource Center Joe West Hall MacQuarrie Hall Modular Units Morris Dailey Auditorium Music Building Other Royce Hall Science Building Spartan Complex Central Spartan Complex East Spartan Memorial Student Services Center Student Union Sweeney Hall Tower Hall Uchida Hall University Police University Theater Washburn Hall Washington Square Hall

If applicable, enter floor number:

If applicable, enter room number:

Describe the type & location of campus access problem you are experiencing. Please be as detailed as possible: