T-Access Request Form Complete this form if you need assistance with on-campus transportation due to a temporary injury or short-term illness. Student InformationName * Required First Middle Last Best Contact Number * RequiredUTK Email * Required Enter Email Confirm Email Address * Required Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you already registered with Student Disability Services? * RequiredSelectYesNoInjury or Illness InformationDate of Injury or Illness * RequiredMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Describe the cause and nature of your Injury or Illness * RequiredExpected Length of Injury or Illness * Required Are you utilizing any of the mobility aids below? Crutches Walker Wheelchair Upload DocumentationUpload a copy of your documentation, including hospital visit, doctor's note , etc. Alternatively, you may email a copy of it to sds@utk.edu. Drop files here or Select files Max. file size: 20 MB, Max. files: 5. Maximum file size - 20 mega bytes. Δ