USF/DIEO/ADA/ ADA ACCOMMODATION REQUEST FORM
ADA PUBLIC ACCOMMODATION REQUEST FORM
In order for the University to address your request, the request must be
received a minimum of 5 days prior to the event.
Please notify Shari Wilson, the ADA Coordinator in the Office of
Diversity and Equal Opportunity at 813-974-0068within 48 hours if you
are unable to attend the event and wish to cancel the requested
accommodation.
1. Applicant Name: ____________________________________________________________
Ph:______________________ E-mail:_________________________________________
2. Event Name:__________________________________ Date:_________ Time:_________
Location:__________________________________________________________________
Sponsor of Event: ______non-USF ______USF Dept
Name of Sponsor _________________________________ ph: _____________________
I do not have this information, it is a public event.
3. Requested Accommodation(s):
ASL Interpreter Braille Event Program Info
Assistive Learning System Wheelchair Accessible Visual Aids
CART OTHER Describe: ___________________________
Accommodation Request Details and/or Comments
(NOTE: Personal assistants are not provided by the University. If you will have someone with you
that needs to be seated/located with you, please check this box
_______________________ ______________________
Signature Date
Deliver to: 4202 E. Fowler Avenue, ALN 172, Tampa, FL 33612
Or FAX to: 813-974-4375,
Or E-mail to: sdwilson@usf.edu
