Classroom Furniture Accommodation Request Form

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Please Note:

It is helpful if you check current classroom arrangements for each of your classes prior to the beginning of the quarter to determine what is already there.
Complete and submit the Classroom Furniture Accommodation Request Form as soon as you know there is a need (prior to the beginning of each quarter).
Notify the DRC as soon as possible if you drop a class in which you requested furniture placement, or if a class is re-located.
Report difficulties or problems to your DRC Access Specialist as soon as possible.
Be aware that it may take up to two weeks for furniture requests to be honored.

Today's Date *

Month

Day

Year

Quarter Furniture is needed for *

Contact Information

Name *

Phone (cell) *

Email Address *

Furniture Request

Type of Furniture (select all that apply) *

Padded chair without arms	Chair without padding, with arms	Adjustable table	Standing desk/lectern type set-up	Other (Describe below in "Other Type of Furniture")
Padded chair with arms	Chair without padding without arm	Foot stool	Standing desk and table at regular height with chair, to move between during class

Other Type of Furniture (Optional, unless you select "Other" above)

Placement of Furniture in classroom (e.g., near door, near instructor, front of class, back of class) *

Building Number and Classroom Number *

Is this for a lab? *

Would you be comfortable if we placed a "Reserved for Student Use" sign on the furniture? (No ADA symbol will be used) *

Upload photo example of desired furniture (Optional)

Feel free to upload a photo or photos of the furniture that you are requesting if that would help clarify your specific needs. Please note: The photo(s) would only be used for reference purposes by Facilities staff. We cannot guarantee that you will receive the exact same furniture that is in your photo(s).
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.

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Classroom Furniture Accommodation Request Form

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