DPS Furniture Request Form

Accessible Furniture and Accessories Request Form

Chaffey College recognizes the importance of providing equal access to education for students with disabilities. As a part of its commitment, the Disability Programs and Services (DPS) offers accessible furniture in classrooms as an approved accommodation for such students. This accommodation includes adjustable height tables, padded and adjustable chairs, stools, and podiums for those who need to stand.

To request accessible furniture in classrooms, students must ensure they have this accommodation listed in their Simplicity Accommodate account. DPS will work collaboratively with campus departments to ensure that the requested furniture is placed in the classrooms within a reasonable timeframe. If the placed furniture does not meet the student's needs or has been moved from its original placement, Jason Schneck (Alt Media Tech Specialist) can be contacted at 909-652-6393 or via email at Jason.schneck@chaffey.edu.

Name*

First Name

Last Name

Student ID Number:*

Phone*

Type of Accessible Furniture needed:

Padded Chair Adjustable Table Foot Stand/Rest Sit/Stand Table

Other:

Date/Time of request:

Classroom #1 needing this Accommodation:

Do you have another classroom needing furniture/other accommodations?

Yes No

Classroom #2 needing this Accommodation:

Do you have another classroom needing furniture/other accommodations?

Yes No

Classroom #3 needing this Accommodation:

Do you have another classroom needing furniture/other accommodations?

Yes No

Classroom #4 needing this Accommodation:

I acknowledge that Disability Programs and Services (DPS) at Chaffey College offers specialized furniture and technology in classrooms to accommodate the ergonomic needs of students with disabilities. This equipment is provided on loan and is semester-by-semester basis. As a student, I understand that it is my responsibility to submit any furniture requests with DPS at least three weeks before the start of each semester. Requests made after the start of the semester may take up to a week or more for placement to be completed. In the event that the provided furniture or equipment is lost, moved, or damaged, I will immediately report any issues to Jason Schneck (Jason.Schneck@chaffey.edu) or the DPS front desk (909-652-6379). I understand that failure to report any damage or loss may result in a hold on my student account and/or charges for the replacement or repair of the equipment.*

I agree