Accessibility Accommodation Request Form

The Bill Memorial Library seeks to provide reasonable accommodations for physical access, communications, or other needs to ensure that services, activities, and programs are available to individuals with disabilities. Please complete the following form regarding your reasonable accommodation request and submit it no later than 14 days before the program. Your request will be addressed as expeditiously as possible.

The Americans with Disabilities Act (“ADA”) does not require the Bill Memorial Library to take any action that would fundamentally alter the nature of its programs or services, or impose an undue financial or administrative burden.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

What service, program or activity does this request concern?

What is the disability that makes an accomodation(s) necessary? (Specify)

What accommodation(s) are you requesting?

Please provide any additional information that might be helpful in processing your accomodation(s) request.

BILL MEMORIAL LIBRARY

Accessibility Accommodation Request Form

Hours

Location