Access Request for Deaf Professional/Learner

Requester Name

Requester's Email

Deaf Professional/Learner/Attendee Name

Are there any additional Deaf Professionals who are known attendees not already listed?

What are the names of the additional Deaf attendees?

Type of Access

Please specify

Event Title

Event Date(s)

Start and End Time

Event Location

Building Name

Room Number

Any special instructions for access providers. (ie. directions to room, building entry codes, door to enter, etc.)

If the area requires swipe access, and the interpreter is not a UR employee, who can the interpreter contact to be let in? (ie: name, phone number, text number, etc)

Virtual Meeting Link

What is the nature of the appointment or event? (e.g., educational class, 1:1 or group meeting, weekly department meeting, lab session - please specify the type of lab, etc.)

Please indicate the role of the Deaf individual (e.g. student, staff, faculty, researcher, community member, etc.)

Do you have any special instructions or requests for the interpreter? (e.g., directions for those unfamiliar with your room, dress code, food/drink restrictions, allergy considerations, etc.)

Will there be any presentation or speaker notes during the appointment or event that the interpreter should be aware of in advance? Who should we contact to obtain a copy of the presentation slides and/or speaker's notes?

Upload any relevant files for the event here.

Department Name

Company Number

Grant Account Number (if applicable)

Department Contact Name

Department Contact Email