Website Accessibility Feedback and Accommodation Request Form

Website Accessibility Feedback and Accommodation Request Form
We are committed to ensuring our website is accessible to all users, including people with disabilities.

If you encounter an accessibility barrier on this website or need an alternative method to access information, please let us know by completing this form. Your information will be kept confidential and used solely for the purpose of improving website accessibility and responding to your request.

Please note: This form is only for website-related accessibility requests. For other types of accessibility requests, please contact the relevant departments.
Is this accessibility request related to the website?
Name

First NameLast Name
Email
Enter a valid email if a response is requested. Use this format: example@example.com
Phone Number
Provide a valid phone number.Format: (000) 000-0000.
Type of Accessibility Request
Assistive technology used (if applicable)
Describe the website accessibility issue encountered or the accommodation requested:
Provide as much detail as possible about the issue encountered or accommodation needed.
Web address or page URL where the issue occurred (if applicable)
Department
Select what department web page. Select N/A if not sure.
Date

MonthDayYear
Non-website accessibility/accommodation requests

This form is intended for accessibility requests related to the website ONLY.

For other requests, please contact the County department you need help from.
Please verify that you are human
Should be Empty:

Website Accessibility Feedback and Accommodation Request Form

Non-website accessibility/accommodation requests