Section 1 of 1 in this document
City of Huntsville
Huntsville Transit ADA Complaint Form
Complainant information
First Name
*
Last Name
*
Phone number
*
Street Address
*
City
*
State
*
Zip
*
Person discriminated against (if other than the complainant)
First Name
Last Name
Phone number
Street Address
City
State
Zip
What was the discrimination based on? (Choose one)
*
Choose One
Disability
Other
Date of incident
Please describe how you or another person were discriminated against. What happened and who was responsible?
*
Did you file a complaint with a federal, state or local agency or with a federal or state court?
Choose One
Yes
No
If you answered "Yes" above, please check the agency or agencies where the complaint was filed.
Federal Agency
Federal Court
State Agency
State Court
Local Agency
Please provide contact information for the person who took your complaint.
First Name
Last Name
Street Address
City
State
Zip
Date filed
Sign the complaint in the space below.
Sign the complaint in the space below.
First Name
Last Name
Email
Choose how to sign
Draw
Type
I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.
Please attach any documents that support your complaint.
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