The City will make all reasonable modifications to policies and procedures to ensure that individuals with qualified disabilities have an equal opportunity to enjoy all City programs, services or activities.

The City has the right, on a case-by-case basis, to determine whether a request is “reasonable” and whether or not the accommodation can be provided without jeopardizing the safe operation of the program, service or activity. The City shall not be required to make any modification that fundamentally alters the nature of the program, service or activity, or would result in undue administrative or financial burdens, as determined by the head of the department offering the program, service or activity. Requests for accommodation should be submitted as far in advance as possible, but not later than 48 hours prior to the need for the accommodation.

Please use the form below to submit a request for a modification to policies or procedures in order to equally participate in City of Richardson programs, services or activities or to request removal of architectural barriers in City facilities.

1

Today's Date

 *

Today's Date

2

Contact Information

 *

Contact Information

Applicant's Name (First, Last)

Contact Name (First, Last) if different from applicant

Street Address

City

State

ZIP Code

Phoneext.

Email

3

Preferred Contact Method

Preferred Contact Method

Mail

Phone

Email

4

Relationship to Applicant

Relationship to Applicant

Self

Spouse

Parent or Legal Guardian

Other If other, type text here.

5

Type of Request (Select all that apply)

Type of Request (Select all that apply)

ASL Interpreter	Assistive Listening Device
Material in Braille	Large Print Material
Audio Recordings	Curb Ramps
Sidewalk Installation or Repair	Site Modification
Other If other, type text here.

6

Name or address of facility for which the accommodation is being requested

 *

Name or address of facility for which the accommodation is being requested

7

Name of program, service or activity for which the accommodation is being requested.

Name of program, service or activity for which the accommodation is being requested.

8

Department offering the program, service or activity (if applicable)

Department offering the program, service or activity (if applicable)

9

Date of program, service or activity

 *

Date of program, service or activity

10

If the request is for a curb ramp or sidewalk, please list the nearest intersecting street

If the request is for a curb ramp or sidewalk, please list the nearest intersecting street

11

Specify the reason(s) you are requesting an accommodation (select all that apply)

Specify the reason(s) you are requesting an accommodation (select all that apply)

To provide full access to City facilities

Other If other, type text here.

12

Describe the specific accommodation(s) you are requesting

 *

Describe the specific accommodation(s) you are requesting

13

Describe how this accommodation will assist you

Describe how this accommodation will assist you

Online Submission Notification
All requests submitted online are sent directly to Lindsay Turman, the City of Richardson ADA Coordinator for action. The City will provide written acknowledgment of your request within 10 days. A written response to your request will be provided no later than 21 days from receipt of the request.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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