ACA Accommodation Request Form

** Click on this link to read ACA's accessibility statement and to read more about our associated policies and practices. **

First & Last Name

Participant's Name (if same, write "Same")

Your relationship to participant (e.g. If you are submitting this form on behalf of a child, please indicate this below. If you are the participant, write "N/A")

Cell phone #

Home phone #

Email address

Please select all of the programs you will be participating in at ACA.

Semester Course (Fall, Winter and/or Spring Term)Camp Program (Feb, April and/or Summer)ACA Event (Gallery Reception, Ticketed Event, etc.)

Other:

Are there are any specific accommodations you would like to request in advance of your participation in ACA's programs? Please use the section below to let ACA know how we can best meet your needs.

Any other special notes, comments, questions? Please feel free to use the section below.