2. Instructions for Submitting Form

   If you require an accommodation under the Americans with Disabilities Act (ADA) for a program or service, it is recommended that you make your request at least two weeks in advance in order to allow North Metro Fire time to review your request and make arrangements for the accommodation. All requests for accommodation, regardless of timeliness, will be given due consideration and if necessary, may require an interactive process between the requester and the fire district to determine the best course of action.

   If you need assistance in filling out this form, please contact the public information officer or ADA coordinator at 303-452-9910 or via our contact us form. When you are done completing this form, please hit the "submit" button below. You will be notified by email once a decision is made on your request. Additional information may be needed to process your ADA request.

4. Name*
5. Email Address*
7. Address
9. City
10. State
11. Zip Code
13. Phone Number*
14. Is this a TDD number?*

    1. Yes
    2. No
16. Please provide the date, time and location that an accommodation is requested.*
18. Please describe the physical or mental limitation necessitating accommodation.*
20. Please explain the type of accommodation(s) requested and any special requests or anticipated problems. Primary consideration will be given to the requested accommodation; however, North Metro Fire reserves the right to offer an alternative accommodation if one is more readily available and equally effective in accommodating your needs*
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field