Academic Ceremonies - December Commencement

December Commencement Ceremony Deaf and Disability Accommodation Request Form

Deaf and Disability Accommodation Request Form

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:

*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:


Permits and maps will be emailed a week before December Commencement. If you submit a request after December 6th, 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:


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 main entrance of Patrick Gym/Multipurpose Facility 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 with local area vendors for availability.

Number of individuals who walk with difficulty:


Interpreter services needed:

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?


Sign language interpreter needed?


Number of people in party requesting disability related accommodations:

Additional Information:

Last modified November 08 2013 01:09 PM

Contact UVM © 2014 The University of Vermont - Burlington, VT 05405 - (802) 656-3131