Westfield State University

Evacuation Assistance

Individuals who believe that they may need assistance, even if only on a temporary basis, from emergency personnel to evacuate campus buildings may request that assistance by filling out and submitting the form below. This form will be sent to University Police. We encourage you to discuss the specifics of your request with University Police, Disability Services, or the ADA Coordinator.

For more information regarding emergencies on campus, please visit Emergency Preparedness and Response. 

For information regarding services for people with disabilities, please contact Disability Services, or the ADA Coordinator.

First Name	*
Last Name	*
Are you a	*	Student Employee Guest
Do you live in a residence hall at WSU?	*	Yes No Yes, but I don't have my assignment, yet
If so, what is the name of the residence hall?
What is the room number?
Do you work in a campus building?	*	Yes No
If so, what is the name of the buidling?
What is the office/room number?
If you are a GUEST, what buildings will you be visiting?
Cell phone number	* just numbers, i.e., 4135555555
The e-mail address submitted must be a WSU e-mail address for validation purposes. If you are a guest, please write in your personal email address.
Westfield e-mail address	*
Reason for requesting assistance (check all that apply)		Mobility Vision Hearing Other
If other, please discuss with one of the contacts noted above.
How long do you expect to need this assistance?	*	Permanently Temporarily
If temporarily, please choose the most likely timeline		1-2 weeks 2-4 weeks 1-2 months 3-5 months 6-9 months 9-12 months one year or more
Is there anything else you would like to share (i.e., wheelchair use, accompanied by an assistant)