Get Ri Governor's Commission On Disabilities Ri Gcd Form D 3 ...

This guide provides clear and supportive instructions for completing the RI Governor's Commission On Disabilities RI GCD Form D 3. This form is used to file a complaint regarding discrimination in public accommodations due to a disability.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill out the complainant’s name, contact information, and address. Ensure that your daytime phone number and email address are correct for any follow-up communication.
3. Provide details about the government agency or business you are filing against, including the director’s name and title, agency name, and address.
4. If relevant, include the full name, address, and phone number of the individual who discriminated against you.
5. Indicate the type of business or agency involved in the discriminatory action by checking the appropriate box. This could range from a restaurant to a health care provider.
6. Specify the date(s) when the alleged discrimination occurred—either once or ongoing—by filling in the required fields.
7. Select all applicable reasons for the discrimination you experienced due to your disability. Check each box that describes how services were denied or different from those provided to others.
8. Describe in detail the actions taken against you that you believe are discriminatory. Include relevant names, dates, and any documents related to the incident.
9. If applicable, enter information about any agencies or lawyers you consulted regarding your complaint and describe the outcomes of that assistance.
10. Review the entire form for accuracy and completeness before signing. Ensure that you agree to participate in mediation efforts as outlined.
11. After completing the form, save your changes. You can then download, print, or share the completed form as needed. Email the form to disabilities@gcd.ri.gov if signed electronically or mail it to the address provided, keeping a copy for your records.

Complete your form online today to ensure your voice is heard.