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Request for Reasonable Accommodation or Modification

The City of Milwaukee is committed to compliance with the Americans with Disabilities Act (ADA) in all aspects of providing equal access to all city-sponsored programs and events and does not discriminate on the basis of disability in the city’s services, programs or activities. This form may be used by citizens to request a reasonable modification to the accessibility of a city program, service or facility. Please submit the form no later than 72 hours before the event for which an accessibility modification is needed in order for us to honor your request.


Required fields are marked with an asterick *

Your Name *

Email Address *

Your Address

City

State

Zip Code

Daytime or Cell Phone


Program, service or event for the request *

 

Location of program, service or event *

 

Date of program, service or event (Enter as MM/DD/YYYY) *

I am requesting the following accommodation or modification.  *
To select multiple options, hold down the Shift key as you click one or more listed option.


If you selected "Printed Material" as your accommodation or modification, in the previous question, please describe the material and desired format type:

(Please provide a week advance notice for requests of printed materials in Braille.)

If you selected "Other" as your accommodation or modification, in the previous question, please describe your request:

Please provide any additional details necessary to process this request:

Department Logo US Department of Justice Logo

Rebecca Rabatin - ADA Coordinator
(414) 286-3475


Download a Printable Request Form


Request by Mail

If you do not wish to send an electronic request, you may contact the ADA Coordinator’s Office at (414) 286-3475, or submit the information in writing (with at least a 72 hours advance notice) via US Mail to:

Rebecca Rabatin, ADA Coordinator
City of Milwaukee
Department of Administration
Budget and Management Division
200 East Wells Street, Room 603
Milwaukee, WI 53202