Report A Facility Access Barrier

Please fill out this form to report a facility access barrier at the University of Arizona

First Name:

Last Name:

Phone:

Email:

Status:

Describe the accessibility barrier (please be specific):

Building Name:

Building # / Location:

Specific Area / Room Number (Enter Location and Description of Problem):

Person to whom initial report was made:

Name:

Position:

Phone:

Email:

Have you made any other contacts to try to rectify the problem?

Yes No

If yes, please provide the following information:

Name:

Position:

Phone: