Reasonable Modification Accommodation Request

Reasonable Modification Accommodation Request (TheBus)

All federally funded public transportation entities are subject to provide reasonable accommodations by making changes to policies, practices, and procedures if needed for an individual with a disability to use TheBus, unless providing such accommodations are an undue financial and administrative burden or constitute a fundamental alteration of the program or activity.

Please complete the form below if you are placing a reasonable modification accommodation request.

Contact Information

Date:	e.g. 07/10/2015
* First Name:
* Last Name:
* Address:
* City:
* State:	* Zip:
Phone No:	- - format: 808 123-1234
Email:	e.g. abc@domain.com
Please explain what policy or procedure is preventing you from using TheBus services: max 5000 characters characters left
Why is a modification needed in order to allow you to use TheBus services? max 5000 characters characters left
Signature:	Date Signed:
Note: Requests to accommodate a medical condition will require supporting documentation from a medical professional stating the barrier to using the service and the duration of the condition. You will receive a response to your request within 30 calendar days of receipt of your request.
* denotes required fields