This form is an initial step in processing your request for an accommodation under Title II of the Americans with Disabilities Act. An accommodation is a reasonable modification or adjustment that enables a qualified person with a disability to enjoy the same access to employment, facilities, services, activities and programs that are enjoyed by persons without disabilities.
To determine whether you are eligible for an accommodation under the Americans with Disabilities Act, the Americans with Disabilities Act coordinator may ask for documentation of your medical condition. Having a medical condition alone is not enough to make you eligible for an accommodation. Under the Americans with Disabilities Act, a person with a disability must have a physical or mental impairment that substantially limits one or more major life activities, such as breathing, eating, sleeping, walking, talking, manual tasks, hearing, caring for oneself, standing, lifting and reading.
The Americans with Disabilities Act requires the Americans with Disabilities Act coordinator to keep medical information confidential. However, the law allows the Americans with Disabilities Act coordinator to share information regarding your medical condition with individuals who are considered to have a legitimate need to know this information. These persons can include first aid and safety personnel, personnel investigating compliance with the Americans with Disabilities Act, and other persons considered to have a legitimate need to know. The law does not prohibit you from voluntarily discussing your condition or medical information with others.
If accommodations are needed for an event, please allow as much time as possible prior to the event to process your request and make appropriate accommodations if they are approved.
This field is not part of the form submission.
* indicates a required field