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XIII. Does toilet stall for the disabled have bars on each side of wall? <br />Per Dept, of Rehab. Sect. 504 YES❑ NOF -1 <br />XIV. Is there a telephone reasonably accessible to handicap individuals? <br />Per Dept. of Rehab. Sect. 504 YES[] NOR <br />XV. Is there a water fountain reasonably accessible to disabled individuals? <br />Per Dept, of Rehab. Sect. 504 YES[:] NO❑ <br />XVI. Are auxiliary (supplementary) aides available when requested by the individual? <br />Per CFR Title 20,29,41 YES❑ NOF <br />XVII Do all contracts and agreements signed by the individual contain Employer Equal <br />opportunity employer language? <br />CFR Title 20,29,41 YES❑ NOF -1 <br />I certify that I have validated all responses: <br />W/O/R/K Center Staff Date <br />Service Provider Information: <br />First Name Last Name <br />Service Provider Signature Date <br />Business Address <br />Business Phone Number <br />