Request for Accommodation Form

The City has the right, on a case-by-case basis, to determine whether a request is “reasonable” and whether or not the accommodation can be provided without jeopardizing the safe operation of the program, service, or activity. The City shall not be required to make any modification that fundamentally alters the nature of the program, service, or activity, or would result in undue administrative or financial burdens, as determined by the head of the department offering the program, service, or activity. Requests for accommodation should be submitted as far in advance as possible, but not later than 48 hours prior to the need for the accommodation.

Please use the form below to submit a request for a modification to policies or procedures in order to equally participate in City of Arlington programs, services, or activities.

This form is for use by members of the public only. Current City of Arlington employees must contact the Human Resources Department for assistance.
  • Click here if you would prefer to download a printable version of this form.
  • Contact Information

  • Request Details

  • To select more than one accommodation, hold down the control button when making selections
  • Online Submission Notification

    All requests submitted online are sent directly to the ADA Coordinator for action.