Screen reader support enabled.
Request for Reasonable Accommodations
All changes saved in Drive
Copy responder link
Copy
Published
Request for Reasonable Accommodations
Section 1 of 1
Request for Reasonable Accommodations

Requests for accommodations should be made at least two weeks in advance of the program start date whenever possible. While advance notice is appreciated, we will make every effort to address requests made after that time. Please note that in accordance with Massachusetts law, public places do not have to provide the modification requested, as long as the alternative modification provided is equally effective. Reasonable accommodations can not fundamentally alter the program / service, be an undue financial or administrative burden and can not impact health or safety.

Full Name
Question Type

Loading image…
Answer key
Loading...
Loading…
Date of Birth
Question Type

Loading image…
Answer key
Loading...
Loading…
Address
Question Type

Loading image…
Answer key
Loading...
Loading…
City
Question Type

Loading image…
Answer key
Loading...
Loading…
State / Province
Question Type

Loading image…
Answer key
Loading...
Loading…
Postal / Zip Code
Question Type

Loading image…
Answer key
Loading...
Loading…
Phone Number
Question Type

Loading image…
Answer key
Loading...
Loading…
Program / Activity you are requestion accommodations/ modifications 
Question Type

Loading image…
Answer key
Loading...
Loading…
What type of accommodations / modifications are you requesting?
Question Type

Loading image…
Answer key
Loading...
Loading…
Reason why you are requesting an accommodation / modification
Question Type

Loading image…
Answer key
Loading...
Loading…
Signature
Question Type

Loading image…
Answer key
Loading...
Loading…
Date
Question Type

Loading image…
Answer key
Loading...
Loading…
0 responses
Link to Sheets
Insights
Total points distribution
Loading...
Loading responses…
Full Name
Copy chart
No responses yet for this question.
Date of Birth
Copy chart
No responses yet for this question.
Address
Copy chart
No responses yet for this question.
City
Copy chart
No responses yet for this question.
State / Province
Copy chart
No responses yet for this question.
Postal / Zip Code
Copy chart
No responses yet for this question.
Phone Number
Copy chart
No responses yet for this question.
Program / Activity you are requestion accommodations/ modifications 
Copy chart
No responses yet for this question.
What type of accommodations / modifications are you requesting?
No responses yet for this question.
Reason why you are requesting an accommodation / modification
No responses yet for this question.
Signature
Copy chart
No responses yet for this question.
Date
No responses yet for this question.
Settings
Responses
Manage how responses are collected and protected
Presentation
Manage how the form and responses are presented
Defaults
Form defaults
Settings applied to this form and new forms
Question defaults
Settings applied to all new questions
.
Banner hidden 
Google Account
Holly
hollykmk@gmail.com