ADA Accommodation Request Form

The City of Tallahassee does not discriminate on the basis of disability in admission to, or operation of its programs, services, activities or facilities. This form may be used by individuals with disabilities and/or their companions seeking access to a City facility, program, service or activity.

Applicant Information

* Full Name:

* Home Address:

* City:

* State:

* Zip Code:

* Best Daytime Phone Number:

* Email Address:

Accommodation Information

* The program or facility to which I am requesting access is located at:

* Please provide any other details or information necessary to process this request:

* For security, please verify you are a real person.

* Signature

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