Accessibility Intake Form
Thank you for contacting the Cengage Accessibility Team. We aspire to do everything that we can to support all learners. In order to route your request to the appropriate party and provide an expedient, satisfactory resolution we ask that you take a few minutes to complete our Accessibility Intake Form.
We suggest that you review the form prior to completion; you will not be able to save your responses and/or make revisions once the form is submitted. We will start working toward your resolution when we have received the needed information.
Should you have any questions, please contact our team at firstname.lastname@example.org.
Person submitting this form.
Contact: First Name
Contact: Last Name
Contact: Institution / Organization
Contact: Phone Number
Concern / Request Details
Please list platform if other
Please list product type if other
Learning Management System (LMS)
Please list LMS if other
Issue of Concern: please describe in detail
Please use 2 digit month / day, 4 digit year. i.e. 01/01/2019
Please feel free to attach supporting documents
Screenshots, PDF, Word, etc.
Instructor / Course Information
Instructor: First Name
Instructor: Last Name
Course Name / Section Number
Specific Assignment / Exam Name
iKey of the Institution
Student / Concern Related Information
Technology Used (Computer, tablet - Model)
Assistive Technology Used (include version)
Browser Used & Version
Send me a copy of my responses
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