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2. The City of Winston-Salem is currently completing a new Americans with Disabilities Act Self-Evaluation and Transition Plan. In order to enhance access to programs and services for individuals with disabilities, the City of Winston-Salem is asking for your input.
4. Name of Organization
5. Today's Date
   Today's Date
7. Address
9. City
10. State
11. Zip Code
13. Contact Person
14. Title
16. Name of Person Completing This Form
17. Name of ADA Coordinator(s) for Your Organization
21. These questions have been developed to solicit input from organizations and advocacy agencies with the City of Winston-Salem's efforts to provide services and accommodations for individuals with disabilities and to ask for input regarding how programs, services and activities can be more accessible for individuals with disabilities.
23. What direct communications have you had with the City of Winston-Salem regarding services and accommodations for individuals with disabilities?
24. Are there any specific complaints or problems regarding access for individuals with disabilities to any of the programs, services or activities provided by the City of Winston-Salem?
26. What information or other resources can you supply to help educate or inform the City of Winston-Salem about your organization and your services for individuals with disabilities?
27. What general guidance, advice or assistance can your organization provide the City of Winston-Salem to promote access by individuals with disabilities in its programs, services and activities?
29. What do you feel should be the highest priority for the City of Winston-Salem to improve accessibility for individuals with disabilities?
30. Please add any additional comments.
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32. 1. Receive an email copy of this form.
33. Email address

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