Classroom Relocation Request Form

Student Name:
UIN#:
Email:
Phone Number:

Please provide the following information for all classes for which you are requesting relocation:

Request #1

Class Name (e.g. SPAN 101):

CRN:

Days and Time Class Meets (e.g. 11:00 AM - 11:50 AM MWR for a class that meets on Monday, Wednesday and Thursday):

Current Location (Please provide the building name and room number, e.g. Burnham Hall Room 205) :

Please provide a detailed description of why this classroom is inaccessible for you:

Request #2

Class Name (e.g. SPAN 101):

CRN:

Days and Time Class Meets (e.g. 11:00 AM - 11:50 AM MWR for a class that meets on Monday, Wednesday and Thursday):

Current Location (Please provide the building name and room number, e.g. Burnham Hall Room 205) :

Please provide a detailed description of why this classroom is inaccessible for you:

Request #3

Class Name (e.g. SPAN 101):

CRN:

Days and Time Class Meets (e.g. 11:00 AM - 11:50 AM MWR for a class that meets on Monday, Wednesday and Thursday):

Current Location (Please provide the building name and room number, e.g. Burnham Hall Room 205) :

Please provide a detailed description of why this classroom is inaccessible for you:

For a classroom to be accessible for me, I need (Please check all that apply):

Accessible entrance to the building and to the classroom

(Note: an accessible entrance is defined as one which has an accessible path of travel leading to it; the doorway is minimum 32 inches wide, maneuvering clearance on push/pull side is 60 inches, thresholds are no higher than ½ inch in height, door opening force is no more than 8 lbs for an exterior door and no more than 5 lbs for an interior door; door hardware is operable with a closed fist)

An accessible restroom in the same building as the classroom.

A classroom without brightly-colored walls.

A wheelchair-accessible table in the classroom with an accessible path of travel to the table.

No more than 0.3 mile walking distance from the UIC shuttle bus stop/CTA bus stop or between classrooms for classes scheduled on the same day.

Other. Please Specify:

For questions or comments, contact the Disability Resource Center via e-mail at ACCESSCLASS@uic.edu or by telephone at (312) 413-2183. Thank you.

DRC Classroom Relocation Request Form

Date:

Semester:

Note: For the DRC to be able to process your request in a timely manner, please make sure that you submit your request no later than 2 weeks before the start date of the semester.

Please provide the following information for all classes for which you are requesting relocation:

Request #1

Please provide a detailed description of why this classroom is inaccessible for you:

Request #2

Please provide a detailed description of why this classroom is inaccessible for you:

Request #3

Please provide a detailed description of why this classroom is inaccessible for you:

For a classroom to be accessible for me, I need (Please check all that apply):