City of Providence ADA Grievance Complaint - Online

ADA Grievance Complaint – Online

GRIEVANCE PROCEDURE UNDER THE AMERICANS WITH DISABILITIES ACT

This form may be used by any individual to file a complaint alleging discrimination on the basis of disability in meetings, services, programs, or activities of the City of Providence under Title II of the ADA. Alternate means of filing a complaint, such as personal interviews or tape recordings, are available upon request for people with disabilities. All complaints will be kept on file for a minimum of 3 years.

This Complaint Form (or alternate reporting method) should be submitted by the complainant or his/her designee as soon as possible, but no later than 60 days after the alleged violation.

Complainant Name*
Phone*
Email*
Address
Street Address City State
Date of Alleged Incident*
Month
Day
Year
The alleged act of discrimination involves which City department, meeting, agency or program?*
Describe the alleged act of discrimination:*
Comments
This field is for validation purposes and should be left unchanged.

Leonela Felix, Esq., Ethics Education and ADA Coordinator
401-680-5333 lfelix@providenceri.gov