Accessibility Request
Wittenberg University Commencement
Request Submitted By:
First Name
*
Last Name
*
Cell Phone Number
*
Format: (000) 000-0000.
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Email
example@example.com
Graduate's Given Name:
First Name
*
Last Name
*
Request for assistance with
*
Mobility Issues
Hearing Impaired
Other
Please provide additional information regarding your request for additional assistance:
*
e.g. will need assistance getting to chairs, my grandmother can only walk 10-15 steps
Submit
Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Should be Empty: