2. The City is seeking input from agencies, organizations, and individuals with disabilities to help the City enhance accessibility to its facilities, programs, services and events. The City of Temecula is in the process of preparing their ADA Self Evaluation and Transition Plan which is required by Americans with Disabilities Act (ADA) Title II (28 CFR §35.105(a)). Your input will assist the City in improving its ability to serve the needs of people with disabilities and their families.
4. For any questions, please call: 951-308-6367. Thank you for your time and consideration.
6. First Name
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7. Last Name
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9. Email Address
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11. Address
    Optional
13. City
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14. State
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15. Zip Code
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19. Name of Facility or type of Program or Service you are providing input:*
21. 1. What is your relationship to the City of Temecula?*

    1. Resident
    2. Visitor
    3. Contractor

    1. Employee
    2. Participant of a Program, Service, or Activity
    3. Other
23. If other, please describe:
25. 2. Check all program, services or activities in which you participate at the facility.*

    1. Classes
    2. Recreation
    3. Meetings
    4. Sporting Events

    1. Seminars
    2. Work (Volunteer)
    3. Work (Employee)
    4. Other
27. If other, please describe:
29. 3. Do you know who to contact if you need assistance, have a concern or complaint, or need an accommodation to access a facility, program, service or event:*

    1. Yes
    2. No
31. If yes, who would you contact?
33. 4. Have you ever requested an accommodation for a disability from the City?*

    1. Yes
    2. No
35. If an accommodation was requested, was your request for accommodation made by the City?

    1. Yes
    2. No
    3. Don't know
    4. Not Applicable
37. If yes, what accommodations were made? If no, were you given a reason why it was not provided? Please describe:
39. 5. Have you requested auxiliary aids, an interpreter or specialized equipment?*

    1. Yes
    2. No
41. Was your request for accommodation made by the City?

    1. Yes
    2. No
    3. Don't know
    4. Not Applicable
43. If yes, what accommodations were made? If no, were you given a reason why it was not provided? Please describe:
45. 6. Is information provided regarding accommodations, auxiliary aids (such as assistive listening systems, interpreters, alternate formats, specialized equipment, or assisted services, etc.)?*

    1. Yes
    2. No
    3. Don't know
47. Please describe:
49. 7. Have you experienced any nonaccessible areas or programs?*

    (Examples: no accessible parking spaces, difficulty reaching an accessible entrance, steep ramps, uneven sidewalks, stairs only to the facility, narrow doorways, protruding objects in the hallways, lack of assistive devices, missing or inappropriate signage, lack of interpreters, etc.)

    1. Yes
    2. No
51. If yes, please describe:
53. 8. Are you aware of any areas or elements of the facility that are not accessible to individuals with disabilities?*

    1. Yes
    2. No
55. If yes, please describe:
57. 9. Are you aware of any programs, services or activities that are not accessible to individuals with disabilities?*

    1. Yes
    2. No
    3. Don't know
59. 10. Have you attended any special events at the City?*

    1. Yes
    2. No
61. If yes, did you encounter and non accessible areas?*

    1. Yes
    2. No
    3. Don't know
    4. Not Applicable
63. If yes, please describe event attended and the non accessible area:
65. 11. Is accessible seating provided for individuals with disabilities at meetings, classes, programs, etc. held at the facility?*

    1. Yes
    2. No
    3. Don't know
67. If no, please describe:
69. 12. Has the attitude of the staff of the City of Temecula towards you, or someone you know with a disability, been generally helpful, supportive, positive and proactive I solving accessibility issues?*

    1. Yes
    2. No
    3. Don't know
71. Please describe:
73. 13. What do you feel is the highest priority for accessibility in the City of Temecula?
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75. 1. Receive an email copy of this form.
76. Email address

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77. Submit

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