Community Partnerships, Inc. provides reasonable access to all facilities and services for its consumers, personnel, and other stakeholders.  The agency will ensure that barriers to service provision are addressed satisfactorily. Community Partnerships further ensures that if a barrier--such as architecture, environment, attitude, finance, employment, communication, or transportation--is present, that a process for rectification shall be implemented via the completion of the Request for Accommodations - Removal of Barriers form. (An electronic version of the form is available below). All forms submitted shall be reviewed by the Continuous Quality Improvement (CQI) Committee.

Instructions for Form Completion:

Complete the Request for Accommodations - Removal of Barriers form located below with as much detail as possible.

Submit the form to Community Partnership's  Continuous Quality Improvement Committee via one of the following methods:

• Leave the form in the CPI office where completed and request that the form be submitted to the Continuous Quality Improvement (CQI) Committee in the Raleigh office.

• Fax the form to (919) 782-1485 Attn: CQI Committee

• Mail the form to: Attn: CQI Committee

                                            Community Partnerships, Inc.

                                             3522 Haworth Drive

                                             Raleigh, NC  27609

• Email the form to dmurphy@compart.org

Request for Accommodation - Removal of Barriers Form

CPI Agency Location (please circle):  Raleigh   Durham   Goldsboro

Description of the Requested Accommodation or Barrier:

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Description of Proposed Solution/Temporary Modification:

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Contact Information for Individual Submitting Request:

Name: ___________________________________________________

Street Address:__________________________________________________

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City:____________________   State: _____        Zip: _________________

Phone: ___________________________________________________

Email: ___________________________________________________