Website Accessibility Format Request

1
Community Relations can help if you use assistive technology and the format of any material on this website interferes with your ability to access information.

Someone will contact you within three (3) business days to discuss this information and any additional accommodation, support and service that may be necessary.

If you need assistance in completing the request form, contact The ADA Coordinator, Donna Gray at 336-373-2723.

This online form is subject to the public records law. This communication is not confidential. All threats and harassment will be logged.

*denotes a required field
2
Requestor's Name* This field is required.Please provide your first and last name.
First Name
Last Name
3
Phone NumberPlease provide the best phone number to get in touch with you.
Area Code
Phone Number (and extension if applicable)
4
E-mailProvide your email address.
example@example.com
5
Indicate nature of your website accessibility problem
Huge
Large
Normal
Small
Ok
Ok
6
Preferred format in which to receive the material
7
Web address of the requested material
Should be Empty: