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Reasonable Modification Accommodation Request (TheHandi-Van)

All federally funded public transportation entities are subject to provide reasonable accommodations by making changes to policies, practices, and procedures if needed for an individual with a disability to use TheHandi-Van, unless providing such accommodations are an undue financial and administrative burden or constitute a fundamental alteration of the program or activity.

Please complete the form below if you are placing a reasonable modification accommodation request.

Contact Information
  Date: e.g. 07/10/2015
* First Name:
* Last Name:
* Address:
* City:
* State:      * Zip:
  Phone No: - -  format: 808 123-1234
  Email:    e.g. abc@domain.com


Please explain what policy or procedure is preventing you from using TheHandi-Van services:
max 5000 characters characters left
Why is a modification needed in order to allow you to use TheHandi-Van services?
max 5000 characters characters left
Signature:       Date Signed:    

Note: Requests to accommodate a medical condition will require supporting documentation from a medical professional stating the barrier to using the service and the duration of the condition.

You will receive a response to your request within 30 calendar days of receipt of your request.


* denotes required fields

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811 Middle Street
Honolulu, HI 96819
(808) 845-4500