ADA Feedback Form

2. First Name

3. Last Name

5. Email

6. Are you willing to be contacted for more information?

   1. Yes
   2. No

8. Phone Number

10. Please Provide ADA Feedback Below:

    The City of Burlington is working on a ADA Transition Plan and the City would like your comments and concerns regarding facility accessibility to assist in the development of the Transition Plan. Please help with this process and list your concerns regarding accessibility of the public facilities within the City of Burlington.

Leave This Blank:


12. 1. Receive an email copy of this form.
13. Email address

    This field is not part of the form submission.

14. Submit

* indicates a required field