If provided, your name, phone number, mailing address and email will be kept confidential and stored in a secure database that is not shared with anyone.
If you do not want this information to be stored, please do not provide it. You may choose to remain anonymous.
If your question concerns a workplace accommodation, please complete as many of the following six items as applicable OR go to the bottom of the form to submit a question related to the Americans with Disabilities Act, the Rehabilitation Act, or related legislation.
** Note: JAN can provide technical assistance regarding the Americans with Disabilities Act, but JAN is not a legal service so cannot provide legal advice. If you need legal advice, you should consult a legal service.