PTI ADA Accommodations Request

Our correctional partners require all volunteers with specific medical needs to request Americans with Disabilities accommodations before entering a facility. Please review the list in this form to see if you will need an accommodation.

Please note that these requests must be made EACH SEMESTER. Unfortunately, they do not automatically carry over from term to term or across facilities.

If you have questions or experience problems with the form, please contact Tara at tronda@princeton.edu.

What is your name?*

First NameLast Name

Which accommodation(s) will you request for the coming semester? (Please select all that apply.)*

I must carry medication on me. (NOTE: It is not possible to take injectable medication into facilities with you.)I have an implanted medical device (e.g., insulin pump, pacemaker, etc.).I use a medical assistance device (e.g., cast, brace, walker, cane, wheelchair, etc.).I have a metal surgical implant that will likely set the metal detector off.I require the use of an oxygen tank or other device.I have a guide or service dog. (NOTE: Our partners do not recognize emotional support animals for this purpose.)I have another need that may require ADA accommodation.

If necessary, please describe any need not listed above that may require accommodation.

Our correctional partners require a letter from a physician on letterhead indicating your need for the accommodation. Will you be able to provide this documentation along with your ADA application?*

Yes, I have documentation from within the past year.Yes, but I will need to request documentation from my doctor.No, I do not have documentation and I am unable to obtain it.

Anything else we should know?