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Alternative Format Request Form for People with Disabilties
Please use this form to submit a request to the Queen Anne's County Americans with Disability Act (ADA) Compliance Manager. You can also call 410-758-6080 or email your request to: adacompliance@qac.org
Primary Contact
First Name
*
Last Name
*
Email
*
Phone Number
*
Can the phone number provided receive text messages?
YES
NO
Web Address of the page with the issue (URL)
*
Preferred Alternative Format
*
Choose One
Audio Presentation
Larger Print
Text File
Voice Call Back
Other Alternative Format
Preferred Contact Method
*
Choose One
Call Back
Regular Mail
Text
Email Attachment
Other Preferred Method
Description of the Issue or Need
*
disregard this