Request for City of Phoenix Accommodation

The City of Phoenix Equal Opportunity Department (EOD) administers the city’s Americans With Disabilities Act (ADA) Compliance Program. The Phoenix program ensures that all city programs, services and activities are accessible for people who are living with disabilities. This program is in compliance with federal Title II of the U.S. Americans with Disabilities Act (ADA), Section 504 of the 1973 U.S. Rehabilitation Act and the Arizonans with Disabilities Act.

For additional information about accommodation, please contact:

City of Phoenix Equal Opportunity Department
200 W. Washington St., 15th Floor
Phoenix, AZ 85003-2295
ada@phoenix.gov

602-495-5288/Voice
602-534-1124/Fax
TTY: Use 7-1-1

If you have a request for accommodation, or other questions, comments or concerns, please fill in as much of the following information as possible. City staff will respond to your message during regular business hours and as soon as possible.

* Required

* Your Name

* Your Address

* Your Day Phone

* Your Evening Phone

City Program, activity, or position affected

Date desired (if applicable)

* Description of accommodation requested

* Nature of disability

I hereby request the above accommodation and affirm that I am a qualified individual with a disability pursuant to the Americans with Disabilities Act

* Signature (Type Name or Initials here)

* Signature of Parent or Guardian/Applicant Representative
(If applicant is under 18 years of age)

NOTE: Certification of disability from your physician may also be required.

Before you submit this form, please be aware of the city's policy on use of its systems. The message you are about to send is subject to public disclosure under the Public Records Law. It is not private or confidential and is retained for 90 days.

Request for City of Phoenix Accommodation

NOTE: Certification of disability from your physician may also be required.

In Person:

By Phone:

About Phoenix

Accommodation