ADA Compliance Issue Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please fill out as much of this form as you can. If you need assistance please contact us and we would be happy to provide it. If you don't know the answer to something, please type N/A.

Thank you for taking the time to complete and submit this information. You will receive a response from the DC Public Library within 5 business days. If you do not, please contact us at (202) 727-2142, Videophone: (202) 559-5368, or via email at DCPLaccess@dc.gov.

Name (Last, First) *

Address (Street, Apt # if applicable)
*

City, State, Zip Code
*

Phone
*

Please list if this is a cell phone or landline

Are you a veteran? *

Yes

Preferred form of Contact

Phone

Mail

Clear selection

Clear form

Never submit passwords through Google Forms.

This form was created inside of DC Public Schools.

Does this form look suspicious? Report

Forms