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ADA Request for Accommodation Form
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ADA Public Request for Accommodation
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Complete this section if the individual requesting accommodation is not the individual completing this form.
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Description of the situation or way the program/facility is not accessible
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Please provide names of individuals who were involved in the situation, and include as much detail as possible.
Photo of program/facility that is not accessible
If possible, please share a photo of program/facility that is not accessible
Description of your disability
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Please explain the nature of your disability that limits your ability to participate, and how it impairs a major life function.
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How would you propose to make the program/facility accessible?
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