Attachment L Sample Registration Forms

   

ATTACHMENT L

   

SAMPLE STATEMENTS FOR REGISTRATION FORMS

   

     

The registration form is an opportunity to obtain information about a participant’s needs. The following are three examples of statements appropriate for registration forms:

     

SAMPLE 1

   

   

     

       

     

   

         

I am requesting the following auxiliary aids or services due to my disability: __________________________________________________.          

         

I may be contacted at the following telephone number during day hours for more information: ____________________________.

       

   

     

SAMPLE 2

   

   

     

       

     

   

         

Auxiliary aids or services for individuals with disabilities (e.g., sign language interpreter, large print materials, taped materials, accessible parking) can be provided, if requested in advance. Please call (indicate telephone number V/TTY/TRS) by (indicate deadline date) and speak with (indicate name of a person) to discuss your needs.

       

   

     

March 2008                   Attachment L, Page 1
Disability and Communication Access Board

     

SAMPLE 3

   

     

       

     

   

         

Please indicate any auxiliary aid or service needed, due to disability, that would assist you in participating in the activity:          

         

____ Audiocassette tape

         

____ Large print

         

____ Braille

         

____ Sign language interpreter

         

____ Amplification system, please specify _____________________________

         

____ Accessible parking

         

____ Accessible facility

         

____ Special diet, please specify _____________________________________

         

____ Mobility assistance, please specify _______________________________

         

____ Other, please specify

         

I may be contacted at the following telephone number for more information: ____________________________.

       

   

     

March 2008                 Attachment L, Page 2
Disability and Communication Access Board