CILA CORPORATION
ADA Reasonable Modification Request Form
Requests for modification to the policies, practices, or procedures of CILA CORPORATION to accommodate an individual with a disability may he made either in advance or at the time of the transportation service.Whenever feasible, requests for reasonable modifications shall be made and determined in advance. A reasonable modification related to the ADA Paratransit is a change or exception to a policy, practice, or procedure that allows people with disabilities to have equal access to transportation. Fill out this form with details about your modification request and how it relates to your disability.
Modification Request By_____________________________________________Date:___________________________
Address:___________________________________________________________Phone:__________________________
Modification
for (Name)______________________________________________Date
of Trip:______________________
Describe the modification request for ADA demand response transportation including why the modification is necessary:
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
Signature of ADA Passenger or Guardian________________________________ Date______________________________
Once completed, please mail. or email this form to:
CILA CORPORATION
P.O. BOX 160
FLORA, IL. 62839
618-552-8494
Requests for reasonable modifications may be denied on the following grounds:
1. lt is a fundamental alteration to the nature of the program, service, or activity.
2. It is a direct threat to the health or safety of others,
3. It is not a requirement by the requester to use the service, or
4. The modification creates an undue financial / administrative burden.
CILA CORPORATION will strive to acknowledge and approve or deny requests within three (3) business days of receipt. All riders who are denied a request have the ability to appeal.
All information is kept confidential. All materials are available in accessible format and in languages other than English upon request.