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2. Town of Frederick's Digital Accessibility Accommodation Request Form
4. Name*
6. Person Preparing Complaint (if different from above)
7. Relation of Preparer to Submitter (if applicable)
9. Address*
10. City*
11. State*
12. Zip*
14. Phone Number of Grievant*
15. Email of Requestor*
17. Nature of Request/Issue
19. Please provide a complete description of the specific request/issue:*
21. Program or location/link of the issue on the website (if applicable):*
23. Please state what you think should be done to resolve the request/issue:*
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

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