ADA Request Form

CITY OF MCKINNEY, TEXAS
AMERICANS WITH DISABILITIES ACT ACCOMMODATIONS REQUEST FORM

The purpose of this form is to file a request for accommodation regarding facilities, programs or services related to the Americans with Disabilities Act. The City of McKinney has an internal procedure providing for the prompt review and resolution of accessibility accommodations for any visitor to City programs or facilities, or concerning an employee applicant. If you need help completing any of the requested information, you may contact the ADA Coordinator: contact-adacompliance@mckinneytexas.org or 972-547-2694. All requests must be made at least 48 hours prior to event, meeting, etc.
Date submitted

MonthDayYear
Date
REQUESTOR'S CONTACT INFORMATION:
Name
Address
Telephone number
Email address
example@example.com
If the ADA accommodation request is being submitted for someone other than yourself, please name that individual and provide his/her contact information:
Name
Address
Telephone number
Email address
example@example.com
Your relationship to this person
Accommodation request: Please describe the circumstances and specific location that prompted this request. Please provide as many details as possible including program, service, park or facility name, street address, and etc.
What specific resolution are you requesting for the circumstances or specific location that prompted this request?
Future accessibility: Please describe an accommodation or accessibility improvement that would help provide greater access to this program or facility.
Requestors Signature

Clear
Date

MonthDayYear
Date
Please submit this form/the information on this form to:

ADA Coordinator, Public Works, 3501 N. Cenral Expy., McKinney, Texas 75071 Or email: contact-adacompliance@mckinneytexas.org
Should be Empty:

CITY OF MCKINNEY, TEXAS

REQUESTOR'S CONTACT INFORMATION: