Student Evacuation Request Form

If you have a disability that would prevent you from exiting the building during an emergency evacuation without assistance from an emergency responder, please submit the following information:

Current Class Schedule

Indicate the reason that you would require assistance:



Have you submitted documentation of your disability to the Disability Services Office?


By submitting this form, you are informing the College Emergency Response Team regarding your need for evacuation assistance in the event of an emergency. All information regarding the nature of your disability will be kept confidential.