The information submitted on this form will be collected by the Disability Resource Center (DRC) and shared with the Chancellor's Committee on the Status of Persons with Disabilities (CCSPD) unless a specific request for confidentiality is indicated in the comment section below. All matters will be reviewed by DRC and appropriate campus officials. For response and/or action please complete the follow-up section found at the bottom of the form. Please express your concerns in the form below.
Once you submit the form your identity will be protected and only known as the "firstname.lastname@example.org." If you would like us to follow-up, please provide your contact information:
For questions or to follow-up, contact the Disability Resource Center by e-mail at email@example.com.