Form Center

2. Public Disclosure

   Please note that pursuant to the state's Public Records Act (RCW 42.56), documents are public records and may be subject to public disclosure. 

4. CONTACT INFORMATION
6. Name:
7. Phone Number:
9. Address:
11. Email Address:
13. Signature:
14. Date:
    Date:
16. DESCRIPTION OF ACCOMMODATION REQUEST
18. List all known dates and times the accommodation is needed:
20. Why is the accommodation needed:
22. What accommodation are you requesting:
24. PROVIDE HOW BEST TO CONTACT YOU REGARDING THE REQUEST
26. Select:

    1. Phone
    2. In Person
    3. Email
    4. Mail
    5. Other (specify)
28. It is the policy of the City of Battle Ground to provide reasonable accommodation for access to services and programs for persons with a qualifying disability.
30. For office use only - Action Taken

    1. Request granted
    2. Request denied
    3. Request altered
32. Reason for denial:
34. Accommodation made:
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field