Reasonable accommodation request/grievance form

Please complete this form to request a reasonable accommodation to access the City of Bloomington’s services, programs, or activities OR to file a grievance.

Within 10 business days of the City’s receipt of this form, the ADA Coordinator and appropriate staff will review your submission. During the evaluation process, the City may follow-up with you and engage in an interactive process to gather additional information about your reasonable accommodation request and to determine what will allow you access to the City’s services, programs, or activities.

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The City requests a minimum of 10 business days lead time. If you need assistance sooner, please call the City’s Outreach and Engagement Division at 952-563-8733.
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