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Americans with Disabilities Act (ADA) Discrimination Complaint/Grievance

  1. Note:
    Please let us know if you have any complaints/grievances regarding compliance regarding to the Americans with Disabilities Act (ADA Compliance), and we will do our best to comply!
  2. Information for the person filling out this form.
  3. Information for the Person discriminated against.
  4. Person Discriminated Against*
    Please select the person(s) to reference for this complaint/grievance.
  5. If someone else involved, please add their information.
  6. Complaint/Grievance Information
  7. If you wish to send any pictures or related documents, please upload them using the browse button to add files.
  8. Would you like a response from us?*
  9. Leave This Blank:

  10. This field is not part of the form submission.