Form CC-DC-050 "Americans With Disabilities Act Grievance Form" - Maryland

What Is Form CC-DC-050?

This is a legal form that was released by the Maryland Courts - a government authority operating within Maryland. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2018;
  • The latest edition provided by the Maryland Courts;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form CC-DC-050 by clicking the link below or browse more documents and templates provided by the Maryland Courts.

ADVERTISEMENT
ADVERTISEMENT

Download Form CC-DC-050 "Americans With Disabilities Act Grievance Form" - Maryland

1466 times
Rate (4.7 / 5) 88 votes
State of Maryland Judiciary
Americans with Disabilities Act
Grievance Form
Name:
Address:
Phone Number(s): Work
Cell
Home
Case Number:
Please describe the original ADA Accommodation requested and the reason for the request:
Please describe the alleged discrimination which denied you the provision of services, activities, programs,
or benefits with the Maryland Judiciary:
Please provide the location of the Court/Agency where the above described incident took place and the
date of the incident:
What would you like to see happen?
I request that this information be kept confidential to the extent allowed by law.
This form should be submitted to the Fair Practices Department as soon as possible, but no later than
120 calendar days after the alleged violation.
I certify that to the best of my knowledge this information is true and correct.
Type or Print Name
Date
Signature
Fair Practices Department
580 Taylor Ave., A-2
Annapolis, Maryland 21401
Office: 410-260-3679 Maryland Relay: 711
Fax: 410-841-9849
fairpractices@mdcourts.gov
Reset
CC-DC-050 (Rev. 09/2018)
State of Maryland Judiciary
Americans with Disabilities Act
Grievance Form
Name:
Address:
Phone Number(s): Work
Cell
Home
Case Number:
Please describe the original ADA Accommodation requested and the reason for the request:
Please describe the alleged discrimination which denied you the provision of services, activities, programs,
or benefits with the Maryland Judiciary:
Please provide the location of the Court/Agency where the above described incident took place and the
date of the incident:
What would you like to see happen?
I request that this information be kept confidential to the extent allowed by law.
This form should be submitted to the Fair Practices Department as soon as possible, but no later than
120 calendar days after the alleged violation.
I certify that to the best of my knowledge this information is true and correct.
Type or Print Name
Date
Signature
Fair Practices Department
580 Taylor Ave., A-2
Annapolis, Maryland 21401
Office: 410-260-3679 Maryland Relay: 711
Fax: 410-841-9849
fairpractices@mdcourts.gov
Reset
CC-DC-050 (Rev. 09/2018)