Commencement Accessibility Request

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Rogers State University

Last Name:

First Name:

Middle Initial:

Student ID:

RSU Email:

Personal Email:

Phone:

Preferred Mailing Address:

Street:

City:

State:

ZIP:

Which ceremony are you requesting services for?

Who are you requesting accommodations for?

If this need is for family member(s), how many will need the accommodation?

What is the total size of your party, including accommadation member(s)? If the size of the party is only yourself, then enter 1.

Do you require any special accommodations?

Please list any additional accommodations you may need.

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