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2. Note:
   Please let us know if any of our crosswalks, sidewalks, and/or intersections are not compliant according to the Americans with Disabilities Act. Fields marked with asterisk * are required.
4. Information for the person filling out this form.
6. First Name*
7. Last Name*
9. Email Address
10. Phone Number*
12. Address
14. City
15. State
16. Zip Code
20. Information for the Person discriminated against.
22. Person Discriminated Against*

    1. Myself (the person filling out this form).
    2. Someone else.
    3. Both myself and someone else.

    Please select the person(s) to reference for this complaint/grievance.
24. If someone else involved, please add their information.
26. First and Last Name
28. Email Address
29. Phone Number
31. Address
33. City
34. State
35. Zip Code
39. Complaint/Grievance Information
41. Please describe your complaint/grievance regarding ADA compliance.*
43. Attachment(s)
    If you wish to send any pictures or related documents, please upload them using the browse button to add files.
45. Would you like a response from us?*

    1. Yes
    2. No
    3. Sure, if You Want to
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field