Americans with Disabilities Act (ADA) Program and Facility Users Survey

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.

   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.

   For any questions, please call: 951-308-6367. Thank you for your time and consideration.

6. First Name

   Optional

7. Last Name

   Optional

9. Email Address

   Optional

11. Address

    Optional

13. City

    Optional

14. State

    Optional

15. Zip Code

    Optional

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 Evnets

    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 accomodation 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?

Leave This Blank:


75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit

* indicates a required field