ADA Application for Accomodation Name of Applicant (required) Phone Number (required) Address (required) Email (required) Service, activity, meeting, or program for which accommodations are requested (required) Date Preference (required) Please describe reason for the accommodation (required) Please describe the accommodation requested (required) By signing this Application, the Corporation, Organization or Individual (“Applicant”) identified above agrees as follows: The Applicant has a disability that is covered by the Americans with Disabilities Act (“ADA”) and the Library’s policy. The Applicant acknowledges the Library’s ADA policy. Your Signature (required) Confirm e-Signature Review Electronic Records and Signatures Policy (required)Read our Electronic Record and Signature Disclosure I agree to use electronic records and signatures There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
