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ADA Accommodation Request (Public Accommodations)

Request for modification of policies, practices, or procedures or provision of auxiliary aids by a public accommodation under ADA Title III.

PDF TemplateUse the instructions below to complete this form

Instructions

Address the request to the business or facility manager. Describe your disability and the barrier to access. Propose a specific modification or auxiliary aid (sign language interpreter, accessible format materials, service animal accommodation, physical access modification). Public accommodations must remove barriers when readily achievable and provide auxiliary aids for effective communication. If the request is denied, you may file a complaint with the DOJ or file a private lawsuit seeking injunctive relief.