Public Entity / Click here to enter text. / Date / Click here to enter text. /
Contact Person / Click here to enter text. / Email / Click here to enter text. / Phone / Click here to enter text. /

To begin the self-evaluation, list all the public entity’s departments and programs. Evaluate each of these.

Departments and Programs / Staff Liaison / Evaluation Date / Comments
Recreation Program / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Probation Department / Click here to enter text. / Click here to enter text. / Click here to enter text. /
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New England ADA Center, a project of the Institute for Human Centered Design ADA-Self Evaluation –Departments and Programs

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