|
Service
Desired:
Date of Request
______________________
__Professional/Staff Development
Workshop
Topic:______________________________________________________________________________
Audience:___________________________________________________________________________
__ADA Access Survey of Facilities &
Services
Approximate square
footage of survey
area:__________________________________________________
Services provided to
your
customers/clients:__________________________________________________
____________________________________________________________________________________
__Update of ADA Transition Plan
Date of last ADA
survey:__________________________________________________________________
Date of original
Transition
Plan:_____________________________________________________________
Date of latest update
of Transition
Plan:_______________________________________________________
Time-frame Desired for
Services:
Preferred Start
Date/Time____________________________________________________________________
Preferred End
Date/Time_____________________________________________________________________
Optional Start
Date/Time______________________________________________________________________
Optional End
Date/Time_______________________________________________________________________
Other Information
Needed:
Number participating (if workshop)
______________________________________________________________
Contact Person
______________________________________________________________________________
Contact Address
_____________________________________________________________________________
___________________________________________________________________________________________
Contact Phone & Email Address
__________________________________________________________________
Please save this form as a document and email it
to mckenje@special-access-services.com,
or print it out and mail it to Ken McCormick, Director of
Operations, at Special Access Services, 3401 Spanish Trail, #349,
Delray Beach, FL 33483-4780. | 
