Purdue University is committed to equal access and to providing an environment in which individuals with disabilities can fully access programs, services, activities, and facilities at Purdue.

The information submitted on this form will be collected by the Affirmative Action Office and shared with appropriate campus officials. You are not required to provide your personal contact information. However, if you do provide us with your contact information, you will receive a response indicating that your form has been received, as well as a response within 7-10 business days with a status report of the situation.

Note: Completing this form does not constitute a filed complaint or grievance. To file a complaint or grievance, contact the Affirmative Action Office at 494-7253 or aao@purdue.edu . To learn about the procedures available at Purdue University, take the following link to the Procedures for Resolving Complaints of Discrimination and Harassment.