Request for Reasonable Accommodation Form

Upon request, the Community Library Network provides reasonable accommodations for physical access, communications, or other needs to ensure programs, services, and activities are accessible to people with disabilities. Please complete the form below to request accommodation. If requesting an accommodation for a program or event, please request these services preferably 15 days in advance, but no later than 72 hours before the event.

*'s are Required Fields.

Today's Date: *

Date of Program (if applicable):

Location of Program (if applicable):
—Please choose an option—AtholHarrisonHaydenPinehurstPost FallsRathdrumSpirit Lake

Name: *

Guardian's name (if applicable):

Mailing Address: *

Phone number: *

Email: *

Preferred method of contact: *
—Please choose an option—Phone NumberEmail

Library card number (optional):

I am requesting the following accommodation(s) from the Community Library Network or one of our libraries: (check all that apply) *
A qualified sign language interpreter to allow me to participate in a program or service.Assistive technology to allow me to participate in a program or service.Other

Your completed form will be submitted to:
Randy Zepeda, ADA Coordinator
Community Library Network
Phone: 208-773-1506 ext. 329
Email: ADAcoordinator@communitylibrary.net