Designate Electronic and Information Resources Accessibility Coordinator (EIR-AC)

This form should be completed by the Executive Director or IRM of your agency or institution of higher education. Enter the information for your state agency or institution of higher education and the person authorizing this designation. If you would like to specify additional information, please use the NOTES field at the end of this form.

Fields marked with an * are required.

Organization


Submitter Role*














EIR Accessibility Coordinator (EIR-AC) Designee Information
From what date is this person designated your EIR-AC?


Organization Chart *
Include an organization chart that depicts the EIR-AC’s position. Supported file types are csv, doc, docx, gif, jpg, pdf, png, txt, vds, vdsx, xls, xlsx, zip.

100%, if fulltime role. If less than 100%, enter the percentage of time dedicated to EIR-AC duties

EIR Accessibility Coordinator (EIR-AC) Contact Information
Does designee directly report to agency being served? *































EIR Accessibility Coordinator (EIR-AC) Assistant Information






Additional Information
Attach files, if needed

Use NOTES box to provide any information such as information about a joint EIR-AC, or other special circumstances.