Campus Events Accommodation Request Form
To request accommodations, complete this form, print and sign it, and then submit it via fax, US Mail, or in
person to the ODS)
Date:
Name:
Address:
City:
State:
Zip:
Phone (day):
Phone (Cell):
Title of campus event:
Name of event sponsor:
Phone for event sponsor:
Address of the event sponsor:
Federal Tax ID or Tax ID No. (for the event sponsor):
Date of event (including beginning and ending times location of event):
Nature of disability & diagnosis:
Auxiliary aid, accommodation, and/or service requested:
Adaptive technology or equipment requested:
Type of service provider requested, is there a second preference:
Is there assistance required in an emergency situation:
If alternative formats are requested, what format is needed, is there a second preference:
By signing below, I state I understand that I am registered for accommodations and services with the
Office of Disability Services (ODS) and accountable for any adaptive technology, equipment, and/or
alternative formats on loan from the ODS. I also understand the policies and procedures set forth
under the Holds section of the ODS Policies and Procedures will apply to students and employees of
Drexel University. Guests will be billed for the repair or replacement of equipment damaged or not
returned to the ODS within 5 University working days. Sponsors of the event will be notified only
that an individual with a disability has requested auxiliary aids, accommodations, and/or services for
the event.
University working days means days when the University is open for normal business operations
Signature
To Be Completed by the ODS Only:
Staff Initials
Date Received
Forwarded To
Date Forwarded
Printed Name:
Delivered By