ADA Complaint

Report violations of the Americans with Disabilities Act (ADA).

Your information:

Name

Phone/Email

Date

Address

State and Zip Code

This is regarding a:

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Please describe the inquiry, incident or problem.*

Name

Organization

Address

Date of incident

Phone of organization

Email of organization

Have you filed this complaint anywhere else?

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Did you file the complaint with either a State or Federal agency?

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Please answer the questions below if you have also filed this complaint with a State or Federal agency.

Name

Organization

Address

Date filed

Phone

Email

Send me a copy of my responses