2. Full Name*
  3. Email Address
  4. Home Phone*
  5. Work Phone
  6. Street Address*
  7. City, State, Zip*
  9. Accommodations Requested*
  10. Tarrant County Disclosure Statement *
  11. CAPTCHA*
  12. Submit

Please fill out the following form and press submit.  Information contained within this form is considered confidential, and will only be provided to the parties involved in the evaluation process.

State the accommodation(s) you are requesting for any services, programs or activities made available by Tarrant County, Texas.  Please provide any specific information that you may have relating to sources, names of devices, etc.

Please be aware that some or all of the information that you submit using this form is subject to public disclosure under the Texas Public Information Act. For an overview of this act, visit the Texas Attorney General's website.