Request for Emergency Evacuation Assistance

Any student, staff or faculty member with special needs for assistance during a building evacuation has the responsibility to make this known to the University. The University cannot make an independent evaluation of such needs. Assistance is usually required by those individuals with hearing, visual or mobility impairments.

All information provided will be kept confidential and only those persons/agencies providing any required assistance will have access to these records. Please complete the form below for submission to the Campus Safety Services. Should your medical condition or any other personal contact information change, please advise the Campus Safety Services by resubmitting the form.