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Canton Township Request for ADA Accommodation (11.27.18)

  1. Type of Accommodation(s)*

    Please select all types of accommodation(s) that apply

  2. Please describe the nature of the accommodation(s) being requested. Please provide as much detail as possible, including: specific location, meeting date and time, and class information.

  3. Is your accommodation request time sensitive? *

  4. The requester will be contacted within four business days by appropriate Canton Township staff.

    Canton Township will send email confirmation that your request has been received and is being reviewed within four business days of receiving your request. If you do not receive confirmation that Canton Township received your request for accommodation please contact Human Resources directly at 734-394-5260 to verify the request went through. Reasonable accommodations can be made with advance notice. Contact Human Resources directly at 734-394-5260 if the accommodation request is needed within four business days.

  5. Legal Signature *

    I acknowledge that the information provided is accurate and complete.

  6. Please type full name.

  7. Canton Township ADA Contact Information

    Kerreen Conley, ADA Compliance Coordinator, 1150 S. Canton Center Road, Canton, MI 48188, (734) 394-5260

  8. Leave This Blank:

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