Request for Accommodation Form
Iowa Democrats strive to make all of our events and meetings accessible to all who wish to attend. Reasonable requests will be fulfilled as outlined in the Americans with Disabilities Act, as amended. To provide necessary accommodations please complete the form below and return it no later than 5 days before the scheduled event.

If you require assistance to complete this REQUEST FOR ACCOMMODATION FORM please contact Karen Black, Chair, Disability Caucus: access@idp1st.org.

Name *
Your answer
Address *
Your answer
County *
County (if you live outside Iowa's First District)
Your answer
Phone *
Your answer
Email
Your answer
Requested Accommodations. (Check all that apply) *
Required
Additional Details about your accommodation
Your answer
Date accommodation needed *
MM
/
DD
/
YYYY
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