ADA Non-Compliance Grievance

Grievant Name:
Day Phone:
Mailing Address: (Street, City, Zip)
Email:

Explain in detail the Nature of your Grievance.
Provide the name of the Department and the name of the staff you discussed your accommodation request along with the Date(s) and Time(s) that you spoke with them.
Describe in detail the nature of your limitation.

*Documentation supporting your limitation and need for necessary accommodation should be mailed to the ADA Coordinator at Town of Normal, 100 E. Phoenix Ave., Normal, IL 61761.

Explain in detail why the Department's response to your request for Accommodation is unsatisfactory?

Grievant Signature:
Date:

*An electronic signature is as valid as my personal signature.

This page last modified 02/27/08.