2. The City of Irving 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 to request a reasonable modification to the accessibility of a city program, service or facility. Please submit the form no later than 48 hours before the event for which an accessibility modification is needed.
4. First Name*
5. Last Name*
7. Address Line 1*
9. Address Line 2
11. City*
12. State*
13. ZIP Code*
15. Best Contact Phone Number*
16. Best Contact Email Address*
18. I require Texas Relay Service 711 (TTY)*

    1. Yes

    1. No
20. Program, service or event for the request*
22. Location of program, service or event*
23. Date of program, service or event*
    Date of program, service or event
25. I am requesting the following accommodation or modification:*

    1. Wheelchair Access
    2. Sign Language Interpretation Services
    3. Printed Material in Alternate Format

    1. Modification of Policy or Procedures
    2. Other
27. Other Description
29. Please provide any additional details necessary to process this request:
    500 characters max
31. If you do not want to send an electronic request, contact the ADA Coordinator’s Office at (972) 721-2785, or submit the information in writing via US Postal Service to the City of Irving ADA Coordinator, CIP Department, 825 W. Irving Blvd., Irving, TX 75060.
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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field