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Website Accessibility Complaint and Grievance Form
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Untitled Title
Date of Complaint/Grievance
MM
/
DD
/
YYYY
Complainant Name:
Your answer
Address:
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Email:
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Phone:
Your answer
Website Address (or Location) of Accessibility Problem:
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Description of the Problem Encountered:
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Solution Desired:
Option 1
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Signature (Type Full Name):
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