Disability Grievance and Appeal Form

Today's Date*
MM slash DD slash YYYY
First name*
Last Name*
Carleton email*
This appeal or grievance is related to the following:*
- Academic Accommodations
- Physical Education Requirement
- Housing
- Meal Plan
- Campus Employment
- Other
Were you registered with Disability Services during the term the incident(s) occurred?*
- Yes
- No
Did you attempt to informally resolve the concern before filing a grievance or appeal?*
- Yes
- No
Please describe your efforts to informally resolve the concern.
Please provide a complete description of your grievance or appeal. Provide all relevant details when possible (date and time if relevant, others involved, names of people who observed the incident, description of concern).*
Phone
This field is for validation purposes and should be left unchanged.
Email
This field is for validation purposes and should be left unchanged.