This form may be used by:
· Applicants for employment seeking hiring process or interview accommodations.
· Community members, including prospective students, requesting accommodations for attending events (such as ASL interpretation or CART transcription services), participating in activities, and requesting stadium seatback accommodations.
· Students seeking appeals for Housing or SSD decisions (select General Question/Consultation under Reason for Contact).
· Employees requesting workplace accommodations, submitting general questions, requesting event or activity accommodations, including ASL interpretation or CART transcription services.
· Individuals requesting digital accessibility reviews or consultation.
This form should not be used by:
· College of LSA employees seeking workplace accommodations - contact LSA Disability Navigators
· Michigan Medicine staff (excluding faculty) seeking workplace accommodations - contact the HR Solutions Center
· Students seeking academic or event accommodations - contact Services for Students with Disabilities
· Graduate student employees - contact Rackham Graduate School
· Individuals seeking Paratransit services - complete the SSD request form
If you would like to Report a Barrier to access or Request ECRT Training, fill out our online contact form.
If you have previously submitted a request via this form, do not submit a secondary request here. Instead, log in to your Accommodate case file to submit an additional request. If you do not have a University of Michigan login, please email our team at ecrt-adateam@umich.edu and we will assist you with submitting your additional request.
I have not previously submitted information to the ADA Team via this form.
DEMOGRAPHIC INFORMATION:
This section should be the information of the individual filling out this form. This may not be the person the request is for or who the question is regarding.
STOP! Do not use this form to Request Training or to Report a Barrier. Instead, use the Request Training/Report Barriers Form.
If you do not know your Uniqname, please contact your HR representative. If you are a community member or applicant and do not have a Uniqname, please enter N/A.
How you would like to be addressed by the ADA Team
This is how the ADA Team will contact you. If you do not have a university email, please enter your personal email address.
REQUEST INFORMATION:
Select No if you are submitting this request on behalf of another individual or if your question is in regards to another individual.
Name of the person this request is for, or name of the person this question is about
Supervisor, HR representative, colleague, family member, roommate, etc.
Format example: 22, 12
height x width x depth
Format example: 25, 22, 13-15
Or the first game of multiple you will be attending
I acknowledge I must provide both medical documentation and a photo of my requested seatback before my request may be reviewed.
We can only process requests dated within six months of the date of submission
Detail the frequency and duration for the recurring event
example: 3rd Tuesday of the month for 6 months, July - December
example: Tuesday, Wednesday, and Thursday 11/7-11/9, 3 days in total
Building name and room number. Please refrain from using acronyms.
Street name, suite number, city, state, zip
If applicable
If yes, please explain
Such as employee disciplinary meetings, hearings, Title IX, etc
Please specify what job functions/duties you are having difficulty performing. If you are not sure about the specific accommodation needed, please provide any suggestions about options we may explore.
Select all that apply
Name of individual who helped you and/or the department you worked with
If unsure, please provide an approximate date. Note: Accommodations are not retroactive and accommodation requests may take up to 30 days to be facilitated, or longer in periods of high volume.
Short or long term disability, Family Medical Leave Act, etc
Note: review timelines may vary given capacity. Please allow 15 business days for a review to be completed. Extensions may be necessary in times of high volume. Reviews are not exhaustive, but are a preliminary evaluation.
If you are experiencing access barriers to parking and/or transportation, you may submit this form to request an accommodation. Please note: even with accommodation, you may be required to purchase a parking pass.
You may also report parking and transportation related concerns via our Barriers to Access online reporting form.
Additional services are available to assist employees, students, and community members with transportation at U-M. You can find further information about Paratransit, U-M buses and routes, and after hours transportation options by visiting the respective websites.
If you do not have a parking pass and would like to obtain one, contact the Logistics, Transportation & Parking (LTP) Office
Examples: orange, yellow, blue, gold, accessible
Accessible Verification Decals are provided by the Logistics, Transportation & Parking Office to eligible faculty and staff with active U-M parking permits. A decal is required to park in ADA spaces at U-M.
Provide the building name and address
Please share if the structure or lot is meeting your needs.
Include the disability related impact or difficulties you are currently experiencing related to university parking and/or transportation.
Also include your parking space needs.
Also known as an access aisle or passenger loading zone.
Be sure to include when these accommodations were put into place and when they expired.
Medical documentation may be required to begin processing your request.
If medical documentation is needed and you do not have it currently available, you may be contacted by the ADA Team to provide it at a later date.
Please do not upload extensive medical documentation. You may utilize the Parking Accommodation Medical Form, the Michigan Disability Parking Placard Application (or the application from another state), or a detailed letter from your provider, as available.
If you have questions about what type of documentation is needed, please contact ECRT-ADATeam@umich.edu for details
Generally, medical documentation is required to begin processing your request. Please note: we do not require extensive medical records. You may supply a detailed letter from your provider, as available.
A photo of your seatback is also required.
If you have questions about what type of documentation is needed, please contact ECRT-ADATeam@umich.edu for details.
Generally, medical documentation is required to begin processing your request. Please note: we do not require extensive medical records. You may utilize the Accommodation Medical Request Form or a detailed letter from your provider, as available.
Please provide agendas, PowerPoint presentations, speaker names, handouts, or any other documents that may be helpful in providing services. If not available at time of the submission, you will be contacted to provide these items prior to the event.
Please provide any documentation you currently have available. If additional documentation or clarification is needed, you will be contacted by the ADA Team.
UNIVERSITY INFORMATION:
The ADA Team will not discuss details of your request with your supervisor without your knowledge.
If unknown, please write “unknown.” You can also refer to your supervisor to obtain the name of your unit HR Representative.
The ADA Team will not discuss details of your request with your HR Representative without your knowledge.
OPTIONAL INFORMATION:
The following questions are for data gathering purposes only, but may be helpful in determining future supports at U-M.
You may receive 1-2 emails per month with a list of upcoming events or a newsletter.