Reasonable Modification/Accommodation Request Form

    Contact Information

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    Complainant Information

    Are you filing this complaint on your own behalf? *

    Please explain why you are filing for a third party *

    Have you obtained permission of the aggrieved party you are filing on behalf for? *

    Please state the location to which the modification or accommodate applies to. Please include details such as RVT transit service. RVT facility name/location, route number, vehicle number, and/or bus stop number as applicable: *

    Explain as clearly the details of what is needed in order to equally use RVT services or participate in its programs. *

    Signature

    You may attach any written materials or other information that you think is relevant to your request.
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