ADA Grievance
Name of Complainant:
Your answer
Address:
Your answer
City:
Your answer
State
Your answer
Zip Code:
Your answer
Phone Number
Your answer
Email Address:
Your answer
Individual(s) Discriminated Against:
Your answer
Address:
Your answer
City:
Your answer
State:
Your answer
Zip Code:
Your answer
Phone Number:
Your answer
Email Address:
Your answer
Alleged Violations (Include details of occurrence, dates and individuals/departments involved):
Your answer
Requested Action by the District to Correct:
Your answer
Has a complaint been filed with any Federal/State Agency?
If yes, name of agency and date filed:
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service