ADA Reasonable Modification Request

In accordance with Title II of the Americans with Disabilities Act (ADA), it is the policy of the Memphis International Airport (MEM) to provide individuals with disabilities with a reasonable modification to its policies, practices, and procedures to ensure access to airport programs, facilities, and activities. Please complete this form to request a reasonable modification to a MEM program and/or service. A response to this request will be sent within one (1) to fifteen (15) days from the date of request.

ADA Reasonable Modification Request or Complaint Form

Name(Required)

First Last

Today's Date(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

State your reasonable modification request or complaint:(Required)

Specific date and, if applicable, location where the requested modification is needed, or the complaint refers to:(Required)

How is your disability related to the requested modification? State in detail why the modification is needed:(Required)

If you are submitting a complaint, you may use this area to describe your complaint in detail.

Name

This field is for validation purposes and should be left unchanged.

ADA Reasonable Modification Request or Complaint Form

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