Disability Furniture Form

Furniture Accommodation Request

Name

First Last

DCCC ID

Semester

Course(s) and Classroom Location(s) (Example: ENG 100, Room 123)

Furniture Requested

Ergonomic Chair

Height-Adjustable Desk/Table

Please describe your need for this furniture:

Acknowledgment

I am registered with the Office of Disability Services.

I understand that submission of this request does not guarantee approval and that ODS may contact me for additional information.