ADA Complaint/Grievance Form

The following form is the Town of Porter's ADA Complaince/Grievance Form.
Upon submitting, the ADA Coordinator will review your grievance in a timely manner. If there are any questions about the form or how to fill out and submit the form, please contact the ADA Coordinator.

Upon request, reasonable accommodation will be provided in completing this form, or copies of the form will be provided in alternative formats. Contact: Town of Porter, ADA Coordinator, 303 Franklin Street, Porter, IN 46304. Telephone (219) 395-9921, Fax (219) 395-8811.

ADA Complaint/Grievance Form 2012-1217

Complainant:

Person Preparing Complaint: (if different from complainant)

Relationship to Complainant: (if different from complainant)

Street Address:

City:

State:

Please provide a complete description of the specific complaint or grievance:

Please state what you think should be done to resolve the complaint or grievance:

Please do not contact me personally.

Yes

Signature:

Leave this field blank

Services

Business

Community

ADA Complaint/Grievance Form