Accommodation Requests

Name *

First Name

Last Name

Preferred Method of Contact *

Select all that apply

Phone

Email

Mail

Phone

(###)

###

####

Address (if requesting paper copies)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What type of accommodation are you requesting?

Select all that apply

Printed (paper) copies of digital materials

Large print materials

Braille copies

Closed captioning or transcripts for videos

Alternative digital formats (e.g., screen reader–friendly PDFs)

Language translation or interpretation (please specify language below)

Other (please specify below)

When do you need this accommodation by? *

Note: This form is not monitored 24/7, a member of the WCADAMHS Staff will respond promptly. WCADAMHS hours are 8am - 4pm, Monday-Friday. Closed all major holidays.

MM

DD

YYYY

Would you like someone to follow up with you to ensure your needs are met? *

Yes

No