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Americans With Disabilities Act (ADA) Accommodation Request Form

  1. This form can be completed on this page and submitted when finished at the end, or the form can be printed, completed, and sent to:
    County Administrator's Office, 1100 Simonton Street, Suite 205, Key West, FL 33040, Phone: 305-292-4441, Fax: 305-292-4544
  2. ADA/Human Resources Coordinator Contact:
    Alana Thurston, 1100 Simonton Street, Suite 268, Key West, FL 33040, email:, Phone: 305-292-4461, Fax: 305-292-4454
  3. Additional assistance:
    Contact the County Administrator's Office by phoning 305-292-4441, between the hours of 8:30 a.m. - 5 p.m., if you are hearing or voice impaired, call "711."
  5. PERSON MAKING THE REQUEST (if other than individual needing the accommodation):
  7. Accommodations Requested: please check one of the following six options*
  8. It is best practice to give consideration to the accommodation sought as required under title II of the ADA; however, alternative methods that achieve effective communication are permissible. The County may comply with the requirements of this section through such means as redesign of equipment, reassignment of services to accessible buildings, assignment of aides to beneficiaries, home visits, delivery of services at alternate accessible sites, alteration of existing facilities and construction of new facilities, use of accessible rolling stock or other conveyances, or any other methods that result in making its services, programs, or activities readily accessible to and usable by individuals with disabilities. The County is not required to make structural changes in existing facilities where other methods are effective in achieving compliance with this section. The County, in making alterations to existing buildings, shall meet the accessibility requirements of Regulation 35.151 in choosing among available methods for meeting the requirements of this section, the County shall give priority to those methods that offer services, programs, and activities to qualified individuals with disabilities in the most integrated setting appropriate. Auxiliary aid requests will be provided at no charge.
  9. Leave This Blank:

  10. This field is not part of the form submission.