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Americans with Disabilities Act (ADA) Grievance Form

  1. Note:
    Please let us know if any of our crosswalks, sidewalks, and/or intersections are not compliant according to the Americans with Disabilities Act. Fields marked with asterisk * are required.
  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.