If you have questions or need assistance completing this form, please contact Sharon Mone at (802) 656-7841.

Please Note: All fields with * are required.

*Graduate's First Name:

*Graduate's Last Name:

Will you be attending the reception immediately following the ceremony in the Davis Center

Yes
No

*Requestor's Name:

*Requestor's Phone Number:

*Requestor's E-mail:

*Email Subject Line:
Please type the name of your graduate's last name inside the brackets. DO NOT DELETE "Disability Request Form:", so we can better assist you when referring to your form.

Preferred method of contact:

Email
Phone

Permits and maps will be emailed a week before December Commencement. If you submit a request after December 7th, information will be sent within one business day. If you would prefer to receive via regular mail, please provide mailing address below.

Mailing Address:

City: State: Zip Code:

Accommodations

Number of disabled parking passes needed:

Number of wheelchairs you plan to bring:
UVM will have a very limited number of wheelchairs available to transport individuals from the shuttle to a seat and vice versa. We are unable to provide a wheelchair for all-day use. If a wheelchair is needed for the full day, we recommend you check your local area vendors for availability.

Deaf

Interpreter services needed:

ASL
Signed English
One to One (Deaf/Blind/Deaf-Close Vision)

Blind/Vision Loss

Number of Braille programs needed:

Number of large print programs needed:

Hard of Hearing

Number of amplification ear buds needed:

Number of hearing aid induction loop(s) needed:

Real time open captions needed?

Yes
No

Sign language interpreter needed?

Yes
No

Number of people in party requesting disability related accommodations:

Due to limited seating and the large volume of person requesting accommodations, we are able to provide space for one person to accompany each person requesting seating the section designated for accommodations. Thanks in advance for your understanding.

Additional Information: