SPECIAL ACCOMMODATIONS REQUEST FORM
Name Date of Request
Signature of Parent or Guardian (if under 18)
Name of Program
Date of Program
Time of Program
____ Interpreter for the hearing impaired
____ Sound amplification
If other, please explain how we can accommodate you
Please return this form to the Reference Desk in either Adult or Youth Services Departments.
Note: Requests for special accommodations for the disabled must be made 48 hours in advance of all Library programs.
ST. CHARLES PUBLIC LIBRARY
The purpose of the St. Charles Public Library District is to serve the reading and information needs of the residents and taxpayers of the District. In order to accomplish this, we seek to work with our patrons to make our programs and services readily accessible to them. If you believe there is an area of inaccessibility in your Library, please assist us in overcoming that barrier by answering the following questions.
1. What service(s), program(s) or area(s) of the Library is/are inaccessible to you
2. What suggestions can you make which will assist the Library in dealing with these barriers
3. Would you be willing to work with the Library to identify other areas of inaccessibility which might impede our patrons’ full use of this facility If so, how may I get in touch with you to discuss your ideas
4. Additional comments:
Thank you for your assistance.
Please return to: