Kalamaoo County

Americans with Disabilities Act Grievance Form

Please provide the following information.

* Required 
* Name:
* Address:
* City:
* State:
* Zip:
Home Phone:
Cell Phone:
Email:
 
Date the aggrieved action occurred or was observed:  Select Date
 
Name and location of the County program or service involved that is the subject of the complaint.
Name of program or service:
Address:
City:
State:
Zip:
 
Name(s) of the County employee representative with whom you made contact regarding the subject of this grievance:
     
 
Describe why you believe you are the victim of discrimination on the basis of disability in the delivery of County programs and services:
     
 
* Verification Code: (This helps prevent automated e-mails.)
 
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