Reasonable Modification Request Form
County Connection is committed to providing safe, reliable and accessible transportation services for people in Contra Costa County. To ensure equality and fairness, County Connection is committed to making reasonable modifications to its policies, practices and procedures to avoid discrimination and ensure programs and services are accessible to individuals with disabilities.
Limitations
Please note, a request for a Reasonable Modification will not be considered if it would:

• Fundamentally alter County Connection’s services or programs
• Create a direct threat to the health or safety of others
• Not be necessary to use County Connection’s services
• Cause an undue financial and administrative burden

Request
Describe the modification/s you are requesting that are necessary for using County Connection. *
Please include any information about the issue you are trying to remedy. Please be specific.
Your answer
Contact Information
Full Name *
Your answer
Telephone *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zipcode *
Your answer
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