Facility Access Barrier Form

Please fill out this form to report a facility access barrier at ASU's West campus.

Your Name:*

Phone:*
 (include area code, numbers only)

Email:*

Status:*
Student   Faculty/Staff   Campus Visitor

Describe the accessibility barrier (please be specific):

Building Name:*

Specific Area/Room # (enter location and description of problem):*

Person to whom initial report was made:

Full Name:

Position:

Phone:
 (include area code)

Email:

Have you made any other contacts to try to rectify the problem?*
Yes   No

Full Name:

Position:

Phone:
 (include area code)

Thank you for your submission!