Accessibility Application Your Information Name (required) Address Phone number CellHomeWork Email (required) Do you need a Companion? YesNo Companion Information Name Address Phone number CellHomeWork Email Please identify what most closely matches your disability. HearingSightMobility Do you require a Medical Badge? YesNo (NOTE: This is a badge that lists your current Medical information for EMS in the case of an emergency. It is NOT the accessibility pass, and is not required to be registered for the accessibility pass) What information would you like on the Medical Badge?