Reasonable Accommodation Request
Lexington Recreation and Community Programs is committed to providing reasonable accommodations in accordance with the Americans with Disabilities Act (ADA). All accommodation requests will be reviewed on an individual basis to determine whether they are reasonable and appropriate.
Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Affiliation
*
Please Select
Resident
Visitor
Volunteer
Employee
Participant
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Program / Activity you are requesting accommodations / modifications for
*
What type of accommodation / modification are you requesting?
*
Reason why are you requesting an accommodation / modification
*
Signature
Date
-
Month
-
Day
Year
Date
Requests will be reviewed within 10 business days. All requests are subject to review and approval by the Certified Therapeutic Recreation Specialist (CTRS). A request may be approved as submitted, denied, or an alternative accommodation may be proposed to effectively meet the participant’s needs.
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