Report A Physical or Technology Barrier

Report A Physical or Technology Barrier
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
What is your preferred method of contact?*

PhoneEmail
What is your affiliation with Otero College*

StudentFaculty/StaffVisitorOther
Is this a physical barrier or a technology barrier?*

Physical BarrierTechnology Barrier
Building name or location:
Room number or floor number:
Describe the barrier:*

0/200
Date when you experienced or observed the barrier:

MonthDayYear
Date
Should be Empty: