ADA Reasonable Accommodation Request

This form may be used by anyone who wishes to request accommodation for employment or public participation with the City of New Braunfels.

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Nature, extent, and duration.

Describe the accommodations you believe are needed to enable you to participate in programs, services, or activities with the City of New Braunfels. If you are employed with the City, describe the accommodations needed for you to perform the essential functions of employment.

Provide the name, address, telephone, and fax numbers of your health care provider. The provider may receive a request from us for information regarding your impairment/disability and recommendations for accommodations.

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By checking this you authorize to use this in place of your signature.