Request for Accommodation Form
Complete this form for any food allergies, dietary restrictions, translation, interpretation, educational accommodations (IEP, 504), ADA, disabilities, and other special needs.
The Utah FFA Association is committed to providing equal access to our events and activities for all people. Use this form to request accommodation or assistance at least 30 days before your event. All information submitted in this form will be kept confidential. Our staff will review the request upon receipt and contact the requestor with additional information. The Association cannot guarantee accommodations or assistance if a form is received less than 30 days before an event.
Are you completing this request for:
Please Select
FFA Member
FFA Advisor/Teacher
Adult Volunteer with a Chapter
Committee Member or Judge or Presenter
Other
Reason for completing this form; please select all that apply.
ADA Accommodation Request
Allergy Notification
Educational Plan Accommodation
Medical Accommodation
Special Dietary Request
Special Request/Accommodation
Translation/Interpretation Request
Other
If Allergy Notification was selected, please list allergy.
If Allergy Notification was selected, please identify the exposure that causes the reaction.
Ingestion
Injections
Inhalation
Skin Contact
Other
Today's Date
-
Month
-
Day
Year
Date
Participant's Name
First Name
Last Name
Participant's Email
example@example.com
Participant's Phone Number
Please enter a valid phone number.
Parent/Guardian's Name, if participant is under 21 years of age:
First Name
Last Name
Parent/Guardian's Email
example@example.com
Parent/Guardian's Phone Number
Please enter a valid phone number.
FFA Chapter Name
Advisor's Name
First Name
Last Name
Advisor's Email
example@example.com
Advisor's Phone Number
Please enter a valid phone number.
Utah FFA Event Participant is Requesting Accommodation(s) for:
Please describe the special request/accommodations you are requesting. If request is allergy/dietary related, explain in detail the concern.
If you have received accommodation(s) for previous FFA events, please list the accommodation(s) you have received.
Please provide documentation of the specific diagnosis and limiting nature of the disability/medical condition/allergy by a board certified doctor, psychologist, or psychiatrist. Attach a PDF version of this documentation.
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Name of Individual Submitting Request
First Name
Last Name
Relationship to the Participant:
Email
example@example.com
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