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Allegany County Library System Reasonable Accommodation Request Form
The Allegany County Library System provides reasonable accommodations, by request, for release of certain circulation information and loaning of library material to designated individuals on behalf of library account holders with disabilities. For the purpose of this form, accommodation requests will be considered for persons who have disabilities that are expected to last at least six months. (For accommodations regarding events or programs, please contact the Events and Programming Department.)
This form is for library use only. All information will be kept confidential
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Account Holder Name
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Your answer
Today's Date
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Street Address
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Your answer
City
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State
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Zip Code
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Phone Number
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Email Address
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Library Card Number
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