Use the form below and provide as much detail as possible to address your inclusivity and accessibility. This information is being collected for internal use only and will be used to inform on opportunities and gaps in the Willamette Valley.

A note on Accessibility: In this context, accessibility refers to the ease with which the organization's products, services, and facilities can be accessed and used. Ramps and Braille signage comes to mind when thinking about accessibility, but there are less obvious examples as well including invisible or non-physical barriers. For example, an individual with Autism may struggle with sensory overstimulation in crowded, busy spaces.

First Name *

Last Name *

Company

Address

Address 2

City

State / Province / Region

ZIP / Postal Code

Phone

Website

Email *

Business Description - (include details of how your business can welcome the chosen disabilities)

Choose all that apply:

Can your business or attraction accommodate a person with:

A mobility issue using a wheelchair
A mobility issue using walking canes
A vision impairment
A hearing impairment
Neurodiverse (diverse ways of thinking, learning, processing and behaving. ADHD and Autism are examples)
Other [please explain]

Is your business or attraction:

LGBTQ+ Ally (Welcome/celebrate all individuals/groups and the way they self-identify)
Affordable to all (Offers average fees/services that are accessible to multiple socio-economic levels)

Please help us be more inclusive by self-identifying your business as: