ADA Accommodation Request

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Leesburg Town SealThe Town of Leesburg prohibits discrimination against individuals with disabilities in its services, programs, and activities.

If you require a reasonable accommodation to access a Town of Leesburg service, program or activity, you may request such accommodation one of several ways:

1. Complete the online form below.

2. Complete the ADA Accommodation Request fillable PDF, save it to your computer, and email it to ADA@leesburgva.gov.

3. Submit your request via email to ADA@leesburgva.gov.

4. Contact the specific Town department directly. 

If you need assistance with submitting your accommodation request, please contact the Town's ADA Coordinator at ADA@leesburgva.gov or call 703-771-2700.

Please correct the field(s) marked in red below:

What type of accommodation are you requesting?
What type of accommodation are you requesting?
Contact Information of Individual Needing Accommodation
 *
Contact Information of Individual Needing Accommodation
Contact Information of Requesting Individual, if different.
Contact Information of Requesting Individual, if different.
Detailed Information about Request:
 *
Detailed Information about Request:
  1. To receive a copy of your submission, please fill out your email address below and submit.
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