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Request for Accommodation or Modifications for Alternative Access Form
Title II of the Americans with Disabilities Act

Current step: Contact. Step 1 of 3.
  1. Contact
  2. Request
  3. Review

Form Instructions

  • If you are visiting one of the PPRBD locations and require an accommodation under the Americans with Disabilities Act (ADA), please complete this form prior to your visit.
  • All fields marked "required" must be completed.
  • This material can be made available upon request in an alternative format as required by the Americans with Disabilities Act of 1990.
  • In lieu of submitting this form online, you may choose to download and mail a printed version: Request Accommodation PDF
  • To file a grievance related to problems accessing the website, please visit the Grievance Form page.
  • For other accessibility concerns or to activate the AudioEye toolbar, please visit the Accessibility page.
  • For further assistance, you may direct your request to the ADA Title II and Section 504 Coordinator listed below.

Step 1: Contact Information

Please enter the name of the requestor
Please enter the street address of the requestor
Please enter the city of the requestor's address
Please enter the State of the requestor's address
Please enter the zip code of the requestor's address
Please enter the 10-digit phone number of the requestor

Further Assistance

For further assistance, you may direct your request to the following:

Attn: Tim Hagan
ADA Title II and Section 504 Coordinator
Pikes Peak Regional Building Department
2880 International Circle, Suite 100
Colorado Springs, CO 80910
Email: Accessibility@pprbd.org
Phone: 719-327-2880