DSPS Accommodation Complaint Form

DSPS Accommodation Complaint Form Students registered with the Disabled Students Programs and Services (DSPS) Office who who are dissatisfied with the implementation of an approved accommodation or dissatisfied with a denial of an accommodation request can make a complaint by filling out a DSPS Accommodation Complaint Form.

To initiate an informal resolution process, a complaint form must be submitted in one of the following ways: a) in person to the DSPS Office, b) online via this form, or c) meeting with a DSPS staff member to provide all relevant information regarding the complaint.

1.Student Name First and Last Name

example@example.com

2.Student ID Number

Phone Number

Please enter a valid phone number.

4.Email Address

example@example.com

5.Date of Occurrence

MonthDayYear

6.Class or Location

7.Which of the following best describes your complaint?

Online Course AccessibilityDenial of Accommodation(s) by InstructorWebsite AccessibilityAcademic Counseling ServicesReceiving Accommodations in a Timely Manner

Describe your complaint below. Please provide sufficient detail including all parties involved and all circumstances of the event and/or act for which you are filing a complaint. Please note dates and times if appropriate.

OPTIONAL) If this is related to an accessibility issue, you may attach images, screenshots, supporting documentation that explains your issue. (Non-anonymous question) Upload File. Upload file File number limit: 3 Single file size limit: 10MB Allowed file types: Word, Excel, PPT, PDF, Image, Video, Audio

File Upload