Modification Request Form


April 10, 2018
  • PDF
  • 236 KB


Please complete as thoroughly as possible. Assessment process can take 7-14 days, which means your child may not be able to attend until after assessment process is complete. Return form at any PRCA front desk or email to


The City of Kettering understands the Americans with Disabilities Act requirements.  We invite participation by people with disabilities, alongside people without disabilities, in our programs, sites, and facilities.

We want you to begin the program on time.  The sooner we know about you, and how we can support you in our programs, the more likely you will start the program on time.  However, if delays in communication occur, we will delay the start of program participation.  Please REGISTER EARLY AND SUBMIT THIS REQUEST FORM EARLY!


Once we have received this request form, you will likely be contacted so an interview can be arranged.  This important step allows us to make a plan to support your participation.  You can help by giving City staffs more time.  Please REGISTER EARLY AND SUBMIT THIS REQUEST FORM EARLY.

To make a plan for participation, it may be necessary to meet with you and gather more information.  We will do so as quickly as possible, and ask for your cooperation in arranging to meet as soon as is possible.

Close window