SW Transit » ADA Grievance Form

ADA Grievance

Name of person filing the grievance(Required)

First Last

Address of person filing the grievance(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone of the person filing the grievance(Required)

Name of person alleging an ADA violation (if different than person filing)

First Last

Address of person alleging an ADA violation (if different than person filing)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone of person alleging an ADA violation (if different than person filing)

Email of person alleging an ADA grievance (if different than person filing)

Description and location of the alleged violation and the nature of a remedy sought:(Required)

If the complainant has filed the same complaint or grievance with the United State Department of Justice (DOJ), another federal or state civil rights agency, a court, or others, please enter name of the agency or court where the complaint was filed:

Enter the date of the other filing:

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ADA Grievance

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