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ADA Complaint / Grievance Form
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Online
ADA Grievance Procedures
ADA Projects
Disabled Access
Curb, Gutter and Sidewalk Maintenance
ADA Complaint / Grievance Online Form
Complainant:
Person Preparing Complaint
(if different from Complainant):
* optional
Relationship to Complainant
(if different from Complainant):
* optional
Street Address & Apt. No.:
City:
State:
Zip:
Phone:
E-mail:
Please provide a complete description of the specific complaint or grievance:
Please specify any location(s) related to the complaint or grievance:
Please state what you think should be done to resolve the complaint or grievance:
Please do not contact me personally.
Upon request, reasonable accommodation will be provided in completing this form, or copies of the form will be provided in alternative formats.
Contact the Program Access Coordinator, via telephone (916) 874-6291 or via TTY (916) 875-7105
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