Accommodation Request Form

Knox County Tennessee

Accommodation Request Form

Note: For a fillable version please download the ADA Accommodation Request Form to you computer. The document is in Adobe Acrobat (pdf) format so you must download the form and use Adobe Acrobat Reader to properly view and fill out this document.

AMERICANS WITH DISABILITIES ACT
REASONABLE ACCOMMODATION REQUEST FORM

If not employed by Knox County, what facility, program, activity or service do you need assistance with? (check all that apply)
3. Is your accommodation time sensitive?
4. Have you had any accommodations in the past for this same limitation?



Need Assistance with this form?
Text 865-318-9310 or
TTY 865-215-2497
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Human Resources


Carly Pearson, ADA Coordinator
City County Building
400 Main St, Suite 345
Knoxville, TN 37902
865-318-9310
Judicial Program ADA Coordinator
Elizabeth Golem
400 Main Street, Suite 149
Knoxville, TN 37902
865-215-4437
Marcus Kennedy, Organizational Development Director
400 Main Street, Suite 345
Knoxville, TN 37902
865-215-4427
Text 865-318-9310 or
TTY 865-215-2497
Email