Qualtrics Survey | Qualtrics Experience Management

Student Name:

Student Bearmail Address:

Student Bear Number:

Student Phone Number:

Are you registered with the DRC

Yes
No

Please describe what you are appealing about DRC’s decision about your accommodation request and the reasons for your appeal. Please provide as much detail as possible so the DRC Appeals Designee can understand your concern.

Please describe why you requested an accommodation and how the accommodation relates to your disability specifically in the pursuit of your educational program of study. Reasonable accommodations are provided in order to allow for equal access. They do not guarantee personal success in an academic or workplace environment.

Please describe how your access to the University has been denied or impaired by the decision not to provide your requested accommodation?

Please describe the steps, if any, that you have already undertaken to address the issues that you raise in your appeal, for example, any discussions with your assigned access coordinator or the submission of additional documentation about your requested accommodation to the DRC.

Please include any additional information you believe is relevant to your appeal that you would like the DRC Appeals Designee to consider.

Please attach any supplementary documentation that you believe is relevant to the issues in your appeal.

Please note that if you submit additional disability-related information and/or supporting disability documentation that was not provided at an earlier step in the process, the DRC appeal designee may refer you back to your assigned Access Coordinator to consider this additional information and reassess your accommodation request.