ACCOMODATION REQUEST FORM

All requests will be responded to within 48 hours of submission. A staff member will be in touch with the availability of the request. For more information please email us at info@qaclibrary.org Complete the form below or download PDF.

Type of Accommodation Requested

Program

Facility

Communication

Other

If Other, describe:

Name

First Name

Last Name

Date

MM

DD

YYYY

Phone

(###)

###

####

Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Accommodation Details

Date Program Accommodation is needed:

MM

DD

YYYY

Location

Centreville branch

Kent Island branch

Please describe your request (sign language, interpreter, one-on-one assistance, audio equipment, etc.):

Please include any additional comments:

ACCOMODATION REQUEST FORM

Queen Anne’s County Library

Centreville Branch

Kent Island Branch