Board Meeting Remote Access Request

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Act 393 of the 2023 Regular Session of the Louisiana Legislature amended Louisiana law [La.R.S. 42:14(E)] to allow any member of the public with a disability recognized by the Americans with Disabilities Act (ADA), or a designated caregiver of such a person, to participate in the meetings of public bodies, including the Hospital Service District #2 of LaSalle Parish dba LaSalle General Hospital & LaSalle Nursing Home Board of Commissioners, via teleconference or videoconference if the person requests that accommodation prior to the meeting and if the person complies with the rules, regulations, and procedures adopted by the Hospital Service District #2 of LaSalle Parish dba LaSalle General Hospital & LaSalle Nursing Home Board of Commissioners for such participation.

Louisiana law and Hospital Service District #2 of LaSalle Parish dba LaSalle General Hospital & LaSalle Nursing Home Board of Commissioners Policy permits a member of the public to speak at its meetings before the Board acts on any item on its agenda. Such public participation is limited to three (3) minutes per speaker, and comments must be directed to agenda items. Board agendas are posted on its website at least twenty-four (24) hours prior to its meetings.

Please complete and submit this form if you are a person with a disability recognized by the ADA, or you are a caregiver of a person with a disability recognized by the ADA, and you wish to participate remotely in the public portion of a Board Meeting to provide public comment. To make appropriate arrangements for your electronic participation, we must receive your request to do so at least five (5) working hours prior to the beginning of the meeting at which you would like to speak. (i.e., if the Board Meeting is on Thursday at 1:00 pm, your request must be made before 4:00 pm on Wednesday.) If such request is complete and timely received, you will have the same right to participate in Board Meetings as is provided to persons in physical attendance at same.

PLEASE FILL OUT THE BOARD MEETING REMOTE REQUEST BELOW

Full Name of Participant *

Street Address *

Address Line 1

City

State

Zip Code

Email Address *

Phone Number You Will Conference From: *

I (or the person for whom I serve as a caregiver) request the opportunity to comment at the following meeting *

I (or the person for whom I serve as caregiver) request the opportunity to comment on the following item(s) on the agenda of that meeting: *

Please list Lasalle General Hospital affiliation: *

I am: (check all that apply) *

Employee
Community Member

Certifications & Acknowledgements *

I understand that an individual with a disability is defined by the ADA as a person who has a physical or mental impairment that substantially limits one or more major life activities or a person who has a history or record of such an impairment. Act 393 of 2023 only authorizes electronic participation in Board Meetings by "any member of the public with a disability recognized by the Americans with Disabilities Act or a designated caregiver of such a person." By checking this box, I certify that I am a person with a disability recognized by the ADA or a designated caregiver for a person with a disability recognized by the ADA.
I understand that any member of the public who is permitted to speak in a Board Meeting must refrain from using profanity or inappropriate sounds/language. Failure to comply will result in removal from the meeting electronically or otherwise.
I understand that I will be emailed the contact information for the upcoming teleconference into the Board Meeting, and that I must call into the meeting at least 10 minutes before the meeting begins, from the phone number I have listed above.. Further instructions will be in the email.

By typing my name I am signing this form. *

Date request was made and submitted *