Request for Alternative Format

Please complete the form below. Required fields marked with an asterisk *

Personal information, on this accessibility request form, is being collected under the authority of section 12 of the Integrated Accessibility Standards, Ontario Regulation 191/11 under the Accessibility for Ontarians with Disabilities Act, 2005, and will be used to provide accessible formats and communication supports to Avon Maitland District residents with disabilities.

First and last name*

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Email address

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Phone number

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Title of document*

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URL of where file is located (if possible)

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Which format would you like to request?

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Large print

Plain language

Braille

Audio

Other:

If you require an electronic format, which one?

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Microsoft Word

Rich text format

HTML

PDF

Other:

Please fix the highlighted areas below before submitting.

Request for Alternative Format