Technical Assistance Questions

Use the following form to send a question about workplace accommodations to an Information Specialist.

Please fill out the entire form so we can provide the most helpful response.

*Fields marked with an asterisk are required.

Name:
Street Address:
Address (cont):
City:
*State/Province:
Zip/Postal Code:
Country:
*E-mail:

My primary role is that of: Other:

Choose the medical condition or disability that is related to your question: Other:

Please explain your question in your own words. Provide as much detail as possible.

Functions
Optional: Which of the following functions are involved in your information request? This will help you in defining the problem and aid the Information Specialists in answering your request. Check all that apply.

Balance / Body Control	Behavior	Blind / Visually Impaired
Breathing	Cognition	Communication
Hand Use / Manipulation	Deaf / Hard of Hearing	Health Maintenance
Mobility	Pain	Smell / Taste / Touch

When you have completed your entries, click on the "submit form" button below and your information request will be electronically mailed to the assistive technology information specialists.

This is a publication of the RERC on Workplace Accommodations, which is supported by Grant H133E020720 of the National Institute on Disability and Rehabilitation Research of the U.S. Department of Education. The opinions contained in this publication are those of the grantee and do not necessarily reflect those of the U.S. Department of Education.

Rehabilitation Engineering Research Center on Workplace Accommodations
Center for Assistive Technology and Environmental Access � Georgia Institute for Technology
490 10th Street � Atlanta, GA 30318
Telephone: 800-726-9119 (Voice/TTY) � Fax: 404-894-9320 � Email: