City of IGH Form Center

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Request for Accommodation Form

Person Requesting Action*
Person in Need of Accommodation*
Telephone Number of Person Making Request*
Location of Concern*
Requested Accommodation*
Time Frame Requested*
Identify Issue of Concern*
Contact Information
City Programs & Services
Julie Dorshak, Recreation Superintendent
Email Julie Dorshak
Phone: 651-450-2587
8055 Barbara Avenue
Inver Grove Heights, MN 55077
Employment
Janet Shefchik, Human Resources Manager
Email Janet Shefchik
Phone: 651-450-2512
8150 Barbara Avenue
Inver Grove Heights, MN 55077
Submit this completed form to the appropriate ADA Coordinator:*
1. City Programs and Services: Julie Dorshak, Recreation Superintendent
2. Employment: Janet Shefchik, Human Resources Manager
This document is available upon 3 business day request in alternate formats such as Braille, large print, audio recording, etc.
American with Disabilities Act of 1990 and Section 504 of the 1973 Rehabilitation Act

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