Alternative Format Request Form

Community Support Connections is committed to providing accessible documentation in a format tailored to your needs. By filling out this form, you will be submitting your request to our Manager of Quality, who will work with our staff to fulfill your request.

You may also call our office at 519-772-8787 and make your request over the phone.

Question Title

* 1. Please provide your name and contact information so that we can assist you.

Name (first and last)

Address

Address 2

City/Town

State/Province

Postal Code

Email Address (if applicable)

Phone Number

Question Title

* 2. Please tell us which document(s) you would like to receive and in which alternative format (e.g., HTML, translation to another language, or other technical need).

Thank you for submitting your request.

Question Title

* 3. What date do you need this information provided to you?

Date Document(s) Required

Date