Instructions: Please fill out this form completely.
The Minnesota Government Data Practices Act requires that you be informed that the following information, which you are asked to provide, is considered private.
The purpose and intended use of the requested information is:To assist City staff and designees to evaluate and respond to accessibility concerns.
Authorized persons or agencies with whom this information may be shared include:City of Burnsville officials, staff or designee
Furnishing the above information is voluntary, but refusal to supply the requested information will mean:City staff may be unable to respond to or evaluate your request.