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ADA Title II Grievance Form

  1. Grievance Under Title II of the Americans with Disabilities Act

    Please fill out this form completely and as detailed as you are able.

  2. On or about what date did the subject of the grievance occur?

  3. Where did the act or event causing this grievance occur?

  4. Describe the act(s) and attach any supporting documentation pertinent to this claim.

  5. Has the complaint been filed with the City of Edmond ADA Coordinator or the Federal Department of Justice, or any other State of Federal agency or court?*

  6. Do you intend to file with another agency or court?

  7. Acknowledgement

  8. Please allow 15 days for a response to this grievance.

  9. Leave This Blank: