SIPA Accessibility Request

Online accessibility-related accommodation requests or issue identification should be submitted by this online form or by email to sipa@cosipa.gov. If submitting via email, please include the information requested in this Accessibility Request form.

Alternative means of submitting an issue/request, such as personal interviews or a tape recording of the issue/request will be accepted for persons with disabilities upon request. Though personal details are required to adequately record and respond to the issue/request, these details will be treated with the utmost confidentiality except as required otherwise by Colorado Open Records Act.

Contact Information

Name

Person Preparing Submissions (if different from above)

Relationship of Preparer to Submitter (if applicable)

Street Address of Submitter

City

State

Zip Code

Phone Number of Submitter

Email Address

Accommodation or Modification Request

URL of page with accessibility issue:

Please provide a complete description of the specific request or issue:

If you chose Other, please specify:

Please state what you think should be done to resolve the request or issue:

Is there any additional information you would like to provide?

Contact Information