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How to fill out the ADA Complaint Form online
Filling out the ADA Complaint Form is a crucial step in addressing any discrimination experienced by individuals with disabilities. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently.
Follow the steps to successfully complete the ADA Complaint Form
- Press the ‘Get Form’ button to access the ADA Complaint Form, ensuring that you can fill it out in the online environment.
- Begin with the first section labeled 'Complainant.' Here, enter your name, address, city, state, zip code, and both home and business phone numbers.
- If the individual discriminated against is different from you, complete the section titled 'Person Discriminated Against.' Input their details in the same format as the complainant’s section.
- Move to the next section where you need to identify the government, organization, or institution believed to have committed the discrimination. Provide the name, address, city, state, zip code, and telephone number.
- Specify when the discrimination occurred by entering the exact date. Include a detailed description of the acts of discrimination, listing names of individuals involved where possible. You may use additional space provided on page 3 if necessary.
- Indicate whether efforts have been made to resolve the complaint using NDOT’s internal grievance procedure by selecting 'Yes' or 'No.' If answered 'Yes,' provide the status of the grievance.
- Answer whether you have filed this complaint with another bureau of the Department of Justice or any other civil rights agency or court, indicating 'Yes' or 'No.' If 'Yes,' include the agency or court's name, contact person, address, city, state, zip code, telephone number, and date filed.
- Let the form know if you intend to file with another agency or court by selecting 'Yes' or 'No.' If affirmative, provide the agency's or court's details.
- Use the additional space provided on the form to add any other relevant information or comments that may support your complaint.
- Finally, remember to sign and date the form before submission. Ensure all sections are completed, and then save your changes, download for your records, print, or share the completed form as needed.
Complete your ADA Complaint Form online and take a step towards justice.
The ADA is divided into five titles: Employment (Title I) ... Public Services (Title II) ... Public Accommodations (Title III) ... Telecommunications (Title IV) ... Miscellaneous (Title V)
Fill ADA Complaint Form
Discrimination Complaint Form. Instructions: Please fill out this form completely, in black ink or type. The requested information will assist us in processing your complaint. Please let us know if you require any assistance in completing this form. ADA complaints must be filed within 30 days from the date of the alleged incident. Alternatively, you may send a letter stating your complaint and including all of the information requested in the complaint form. Any person who believes he or she has been subjected to discrimination on the basis of disability may file a complaint under this procedure. A. Contact Information. Date of Complaint: Complainant's Name: Representative Name (if different from Complainant):. You may file a signed, written complaint up to Sixty (60) days from the date of the alleged discrimination.
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