ADA Accommodation Request

2. Individuals with disabilities who wish to participate in Port programs, services or activities and need an accommodation may present their requests for accommodations to the Port by completing this Request for Accommodation form or by calling (360)676-2500 at least 3 days in advance of the event or activity.

   Only those fields with an asterisk (*) are required. All other fields are optional.

4. Name of Contact Person making the request:*
6. Are you submitting this request for someone else?

   1. Yes
   2. No
8. Person accommodation is being requested for:*
10. Email:*
12. Phone:*
14. Preferred method of contact:

    1. Email
    2. Phone
16. Address1
18. Address2
20. City
21. State
22. Zip
24. Please describe your request for accommodation and possible solutions:*
26. Date accommodation needed:*
    Date accommodation needed:
28. Location:*
30. Name of Activity/ Event/ Meeting /Other:*
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field