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ADA Request for Accommodation Form

  1. Complete this section if the individual requesting accommodation is not the individual completing this form.

  2. Please provide names of individuals who were involved in the situation, and include as much detail as possible.

  3. If possible, please share a photo of program/facility that is not accessible

  4. Please explain the nature of your disability that limits your ability to participate, and how it impairs a major life function.

  5. How would you propose to make the program/facility accessible?

  6. Leave This Blank:

  7. This field is not part of the form submission.