Request for Accommodations

Instructions for completing form: Provide your name, address and telephone number. Check the boxes which apply to you and provide any necessary details. When you have completed this request, please return it to the County by clicking the SUBMIT button. For any questions you may call 269-384-8111.

* Denotes required field

Activity you need accommodations for:

What is the nature of your disability?

What type of accommodation are you requesting?

If the request for accommodation is denied or, if the accommodation does not successfully establish effective communication, the applicant may file a grievance in accordance with the County's established grievance procedure.

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