Reasonable Accommodation Request Form - Foothill Transit
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1REASONABLE ACCOMMODATION REQUEST FORM
Please complete this form to request a reasonable modification of Foothill Transit’s
bus services. Submit the completed form to the Reasonable Modification Coordinator
via email at , via fax at 626-915-1143 or via mail at
100 S. Vincent Ave, Suite 200, West Covina, CA 91790.
Date: ___________ Name: _____________________________________________________
Phone Number: ______________________ Email Address: _________________________
Address: ____________________________________________________________________
Description of Request: ______________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
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Location & Routes Used: ______________________________________________________
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Are you able to ride without this modification?: _________________________________
____________________________________________________________________________
Comments regarding a reasonable modification request can be sent to
, or you may call 1-800-RIDE-INFO (743-3463).
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