CDHS Reasonable Accommodation Request Form
CDHS encourages individuals (clients and community members) with disabilities to request reasonable accommodations or modifications to help ensure their effective access to and/or participation in our spaces, programs, activities, meetings, interactions, and services. 

If possible, initiate your request at least 15 days ahead of any meeting or event for CDHS to arrange reasonable accommodations, examples of potential accommodations: interpreter, alternative document formats, support services, or assistive technology/aids.

To request an accommodation or modification from a CDHS division or program, contact the division or program directly or complete this form. Once this form is submitted with sufficient details, the request will be routed to the appropriate program or a support staff to engage in an interactive process to determine and provide reasonable accommodations. 

If assistance is needed to complete this form, please call Client Services at 303.866.3275 (to verbally provide the information for CDHS to complete the form for the requestor) or email CDHS_ADA@state.co.us to arrange a meeting for support with this form.

Please note, CDHS will only respond to emails in which relevant parties are copied. If nonessential staff to the ADA process are copied, we will not respond.


Sign in to Google to save your progress. Learn more
Email *
Name of Requestor *
Please include both the first and last name of the requestor. 
Requestor's Phone Number *
Requestor's County of Residence *
What ADA reasonable accommodation is being requested? *
Please provide as much information as possible, including date, time, and the activity/event/meeting for which the accommodation is requested.
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of State.co.us Executive Branch.

Does this form look suspicious? Report