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Americans with Disabilities Act (ADA) Grievance Form

  1. Title II of the Americans with Disabilities Act Section 504 of the Rehabilitation Act of 1973 Grievance Form

  2. Representative Reporter

    This section is to be completed only if the aggrieved person is not the individual completing this form. Skip to the Grievance Details section if this does not apply to you.

  3. Grievance Details

  4. Describe the situation or way in which the program is not accessible, providing the name(s) where possible of the individuals who were involved in the situation.

  5. Have efforts been made to resolve this complaint through the Request for Accommodation with the ADA Coordinator?*

  6. Leave This Blank:

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