The University of Texas at San Antonio Student Disability Services (SDS)

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The University of Texas at San Antonio
Student Disability Services (SDS)
Accessible Furniture Request Form
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You must be registered and requested your letters of accommodation for the current semester to
request accessible furniture
Please complete all the blanks with the information requested
Allow a minimum of 10 working days for furniture placement into the classrooms
If you have questions please contact us at 210-458-4157
Date of Request:
Semester:
Student Name:
Banner Number:
Telephone Number:
UTSA E-Mail Address:
Course Name, Number &
Section
Instructor’s Name
Year:
Building/Room Number
Day of Class and Time
Date Placed/completed
Building/Room Number
Comments:
For Office Use Only:
Student has requested letters: yes no
Furniture Placed/Date of Placement:
Course Name, Number &
Section
Type of Furniture
date:
Revised 4/2015
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