Accessibility

ADA Accommodation Request

Jefferson County does not discriminate on the basis of disability. Use this form to request an accommodation for access to any County facility, program, service, or activity.

Request an Accommodation Online

Name(Required)

Address(Required)

Telephone Number(Required)

Program or Facility to which you are requesting access (location)(Required)

I am requesting the following accommodation(s)(Required)

Physical Access: Wheelchair Accessibility

Written Material: Large Print

Written Material: Computer Disc

Written Material: Braille

Effective Communication: Sign Language Interpreter

Effective Communication: Verbal Reader (someone to read material to you)

Other (please describe below)

If Other, please describe the accommodation you need

Date of the meeting, program, or activity (if applicable)

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ADA Accommodation Request

Request an Accommodation Online