Communication Accommodation Request Form

4217-F1

Please note: The NWESD 189 needs as much advanced notice as possible to ensure that reasonable accommodations are met. Reasonable efforts will be made to accommodate requests made less than 48 hours in advance of a scheduled program, activity, or event. If aids or services are needed for a meeting of the Board of Directors, please contact the office of the Superintendent directly at 360-299-4002.
Date of request
MM slash DD slash YYYY
Request type (please check all that apply)
- Assistive listening aid or service
- Assistive vision aid or service
- Assistive speech aid or service
- Other
Other details
Contact Persons
Individual making request
Preferred communication
- Email
- Phone
Email
Phone
Event contact person
Email
Phone
Event Details
Event name
Event date
MM slash DD slash YYYY
Start time

: Hours

Minutes

AM/PM
End time

: Hours

Minutes

AM/PM
Event description
Event location
Other relevant details
Upload any relevant supporting information such as event flyer or brochure
Drop files here or

Max. file size: 50 MB.

Contact Persons