Home Departments Executive Department Equity and Inclusion ADA Grievance Procedures Electronic Grievance Form Electronic Grievance Form Edit Form ADA Grievance Form Today's Date* Complainant Name (First, Last)* Address* City, State, Zip* Telephone Number* Email Address* Individual discriminated against (if other than complainant): Name, Address, Telephone and Email Alleged Violation*? Date of Alleged Violation* What efforts have been made to resolve this complaint using the internal grievance procedure of the City Department?* Has a complaint been filed with a State or Federal Agency?* Yes No If Yes, Name of Agency, Contact Person, and Date Filed