Accessibility Request Form

Residents and businesses can submit accessibility requests to the City of Sammamish through the accessibility request form. The ADA Coordinator reviews each accessibility request and a response will be provided via email.

To make a request please contact the City at least 48 hours in advance through this form. If you have questions or concerns about Title VI Accessibility, please contact HR

If the reported situation may endanger pedestrians or bicyclists, please call the front desk at (425)295-0500.

You should receive a copy of your form submittal to the email you listed in the form. If you do not receive an email with a copy of your responses within 24 hours, please email the webmaster with your contact information.

Your Name*

First NameLast Name

Company Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number*

Area CodePhone Number

E-mail*

Choose a primary issue from the list below.*

Street Address*

Cross Street*

Describe Issue*

To be completed by city staff.

Status

OpenClosedDeleted

Closing Procedures

Section 1: Contact Information

Section 2: Primary Issue Location

Section 3: Request Status