Disability Evacuation Assistance Registration Form

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Students whose disabilities, chronic conditions, or temporary injuries may interfere with their ability to evacuate their residence halls unassisted in the event of an emergency or evacuation, are encouraged to alert the Center for Accessibility Resources and Disability Services (CARDS) by completing this form. This information will be shared with Barnard’s offices of Community Safety (CARES), Residential Life, and the local Fire Department of New York (FDNY).

Students with evacuation assistance needs are required to meet with Barnard's Community Safety for individual emergency preparedness and planning consultation, in lieu of fire drill participation. Additionally, students are advised to learn the evacuation plans and routes for their residential and academic buildings.

Individuals with disabilities may be at greater risk during evacuations. The research shows that self-awareness and preparedness affords individuals the best chance for a safe evacuation. CARDS strongly encourages all students who believe that their conditions may interfere with their safe evacuation to review the policies and procedures found here: https://barnard.edu/reslife/fire-safety.

Email *

Student Name (first, last): *

UNI: *

Type of Disability/Chronic Medical Condition: *

Visual Impairment/Blind

Deaf or Hard-of-Hearing

Sleep Disorder

Physical/Mobility

Psychological

Chronic Medical Condition

Other

If other or chronic medical condition, please specify:

Please check all that apply: *

I am not able to hear alarms at all times (due to sleep disorder or loss of hearing)

I am not able to independently get in and out of bed

I am not able to independently transfer in and out of my wheelchair

I have a service or assistance animal

I am not able to use stairs independently

I am able to navigate a limited number of steps/stairs

Required

Do you have medical equipment that is required for daily use? *

Yes

If yes, please describe:

Please list items that must be available to you in the event of an emergency (i.e. charger for motorized chair; medical or communication equipment; medications, etc.):

Please describe your needs for evacuation assistance: *

Submit

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