Form SCA-ADA-03 "Americans With Disabilities Act (Ada) Written Grievance Form" - West Virginia

What Is Form SCA-ADA-03?

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

Form Details:

  • Released on April 1, 1999;
  • The latest edition provided by the West Virginia Supreme Court of Appeals;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form SCA-ADA-03 by clicking the link below or browse more documents and templates provided by the West Virginia Supreme Court of Appeals.

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Download Form SCA-ADA-03 "Americans With Disabilities Act (Ada) Written Grievance Form" - West Virginia

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SUPREME COURT OF APPEALS OF WEST VIRGINIA
AMERICANS WITH DISABILITIES ACT (ADA)
WRITTEN GRIEVANCE FORM
This form may be used by any person who believes that he or she has been the subject of
disability-related discrimination in the employment, practices and policies or the provision of services,
activities, programs or benefits by any unit of the West Virginia court system.
Person filing grievance:
Name:
Address:
Telephone:
Date and location of alleged disability-related discrimination:
Please provide a detailed description of the alleged disability-related discrimination:
(Please use back of form if additional space is needed)
Please provide the names and/or positions of any court personnel involved:
Please state what you think should be done to resolve the grievance:
Signature of person filing grievance
Date
Send completed form to:
ATTN: ADA Coordinator
West Virginia Supreme Court of Appeals Administrative Office
Bldg. 1, Room E-100
1900 Kanawha Blvd. East
Charleston, WV 25305-0145
Telephone:
304-558-0145 (Voice)
304-558-4219 (TTY)
SCA-ADA-03 – Written Grievance Form
Page 1 of 1
Rev. 04//01/1999
SUPREME COURT OF APPEALS OF WEST VIRGINIA
AMERICANS WITH DISABILITIES ACT (ADA)
WRITTEN GRIEVANCE FORM
This form may be used by any person who believes that he or she has been the subject of
disability-related discrimination in the employment, practices and policies or the provision of services,
activities, programs or benefits by any unit of the West Virginia court system.
Person filing grievance:
Name:
Address:
Telephone:
Date and location of alleged disability-related discrimination:
Please provide a detailed description of the alleged disability-related discrimination:
(Please use back of form if additional space is needed)
Please provide the names and/or positions of any court personnel involved:
Please state what you think should be done to resolve the grievance:
Signature of person filing grievance
Date
Send completed form to:
ATTN: ADA Coordinator
West Virginia Supreme Court of Appeals Administrative Office
Bldg. 1, Room E-100
1900 Kanawha Blvd. East
Charleston, WV 25305-0145
Telephone:
304-558-0145 (Voice)
304-558-4219 (TTY)
SCA-ADA-03 – Written Grievance Form
Page 1 of 1
Rev. 04//01/1999