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Online Application

Important Messages

The purpose of this form is to assist the Disability Resource Center (DRC) in determining whether, or to what extent, a reasonable accommodation will provide access in performing the the essential functions of their job safely and effectively. This form will be treated confidentially and filed at the DRC. It will be maintained separately from any personnel records.

You should receive an immediate email confirmation from Arizona.DRC@accessiblelearning.com, acknowledging the receipt of your application. Please contact drc-workplaceaccess@email.arizona.edu if you have any questions regarding this process or have not been contacted within 72 hours of submission.
Personal Information
  1. Note: Select when you would like to start your services.
  6. Hint: Enter 8 alpha numeric characters.
Contact Information
  1. Hint: Enter 10-digit number only.
  2. Hint: Enter 10-digit number only.

Questions

  6. Relationship to Arizona (check all that apply)
  7. Have you previously communicated with a Workplace Access employee? If yes, specify their name in the textbox below. *
  10. Have you previously received an accommodation? If yes, please specify what type in the textbox below. *
  11. Please review the statement below, select the button to agree, and insert your initials in the textbox below. *

Terms and Conditions

By submitting this form, I give the Disability Resource Center (DRC) at The University of Arizona permission to explore reasonable accommodation(s) for my request. This may include an analysis of the essential functions of my position, consultation with my supervisor(s), human resources, any other relevant parties, as well as possible consultation with my health care provider(s).

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