Instructions for ADA Reasonable Modification Request

Please fill out this form completely, sign and mail, fax, or email to:

Gladwin City County Transit ADA Coordinator
615 Weaver Court
Gladwin, MI 48624
989-426-5947 Fax
kim@gladwintransit.com

"*" indicates required fields

Rider:*
Address:*
Address:
How would you like (transit agency) to respond to your request?*

If future communications regarding this request are needed in an alternate format, please indicate the appropriate format below: