ATU information request form

ATU information request form

Whether you're reaching out to us for your own goals or to refer another person who could benefit from our services, we want to hear from you.

Everyone has unique situations and needs, and it's tough to know where to start. Our expert staff will guide you.

1. Your name

2. Phone number answer must be phone number with area code like 217-333-1000

3. Email answer must be an email address

4. Are you interested in any specific services?

4. Are you interested in any specific services?

Activities of daily living

Adaptive equipment

Augmentative communication

Computer access

Environmental control

Home modification

Specialized seating and mobility

Worksite modification

Other

Enter text

5. Are you requesting services for yourself or on behalf of someone you know?

required

5. Are you requesting services for yourself or on behalf of someone you know?

Myself

Someone I know

6. If this is for someone you know, what is that person's name?

7. What is your relationship to that person?

8. Message

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University of Illinois Chicago
1200 West Harrison St.
Chicago, Illinois 60607
(312) 996-7000