The City of Greensboro is committed to ensuring that its facilities, programs and services are available to all persons regardless of their age, color, race, ethnicity, familial status, gender or sex, marital status, mental or physical disability, military status, national origin, political affiliation, race, religion, or sexual orientation. In order to ensure that the City of Greensboro’s ADA Transition Plan Update addresses barrier removal efforts to meet ADA compliance, the City of Greensboro is interested in your opinion.

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* 1. Are you a resident of the City of Greensboro, North Carolina?

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* 2. Are you a person with a disability? (optional) If you would like to volunteer information on your disability, please do so below. If you work with people with disabilities and would like to provide information that may be beneficial please do so below.

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* 3. Please indicate City of Greensboro departments you use below. Select all that apply:

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* 4. Please identify barriers regarding any City of Greensboro facility, program or service that prohibits you or someone you work with from full participation

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* 5. Please provide the following voluntary information in order for the City of Greensboro to track its outreach efforts: Your Name, Address, Phone Number, and Email Address.

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* 6. Please identify your gender. (optional)

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* 7. Please identify your race. (optional)

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