"Americans With Disabilities Act (Ada) Grievance Form" - Minnesota

Americans With Disabilities Act (Ada) Grievance Form is a legal document that was released by the Minnesota Judicial Branch - a government authority operating within Minnesota.

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Americans with Disabilities Act (ADA) Grievance Form
Please provide the following information:
1. Name of Grievant:
Address:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
E-mail address:
2. Date the alleged discriminatory act or decision occurred:
3. Court location and name of the court program or service involved that is the subject of this
grievance.
Court location:
Name of program or service:
4. Type of accommodation requested:
5. Describe the alleged discriminatory act or decision (please be specific):
Please send the completed grievance form to:
ADA Coordinator
125 Minnesota Judicial Center
25 Rev. Dr. Martin Luther King Jr. Blvd.
St. Paul, MN 55155
Or by e-mail to:
ADA.coordinator@courts.state.mn.us
Phone: 651-282-2067
TTY / TDD: 7-1-1 or 1-800-627-3529
Signature of Grievant
Date
Americans with Disabilities Act (ADA) Grievance Form
Please provide the following information:
1. Name of Grievant:
Address:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
E-mail address:
2. Date the alleged discriminatory act or decision occurred:
3. Court location and name of the court program or service involved that is the subject of this
grievance.
Court location:
Name of program or service:
4. Type of accommodation requested:
5. Describe the alleged discriminatory act or decision (please be specific):
Please send the completed grievance form to:
ADA Coordinator
125 Minnesota Judicial Center
25 Rev. Dr. Martin Luther King Jr. Blvd.
St. Paul, MN 55155
Or by e-mail to:
ADA.coordinator@courts.state.mn.us
Phone: 651-282-2067
TTY / TDD: 7-1-1 or 1-800-627-3529
Signature of Grievant
Date