"Americans With Disabilities Act (Ada) Grievance Form" - City of Ionia, Michigan

Americans With Disabilities Act (Ada) Grievance Form is a legal document that was released by the City Manager's Office - City of Ionia, Michigan - a government authority operating within Michigan. The form may be used strictly within City of Ionia.

Form Details:

  • Released on October 1, 2021;
  • The latest edition currently provided by the City Manager's Office - City of Ionia, Michigan;
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  • Fill out the form in our online filing application.

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Americans with Disabilities Act (ADA)
Grievance Form
Street Address: 114 North Kidd Street, Ionia, MI 48846
Mailing Address: P.O. Box 496, Ionia, MI 48846
Ph: (616) 527-4170
Website:
www.ci.ionia.mi.us
Date: __________________
Purpose:
Use this form to file a grievance if you find that the City of Ionia has not provided
adequate accommodations for disability.
Instructions: Please complete this form and submit to the City Manager no later than 60
calendar days following the alleged violation. The ADA Coordinator will respond
to any grievances within 15 days.
Grievant Information
Name of Grievant: _______________________________________________________________
Person Preparing Grievance (If different): ____________________________________________
Address of Grievant: __________________________ City, State, Zip: ______________________
Phone: _____________________________________ Email: _____________________________
Date(s) the Incident Occurred: _____________________________________________________
Incident Details
Please provide a complete description of the specific complaint or grievance:
Please specify any location(s) related to the complaint or grievance (If applicable):
1
Created October 2021
Americans with Disabilities Act (ADA)
Grievance Form
Street Address: 114 North Kidd Street, Ionia, MI 48846
Mailing Address: P.O. Box 496, Ionia, MI 48846
Ph: (616) 527-4170
Website:
www.ci.ionia.mi.us
Date: __________________
Purpose:
Use this form to file a grievance if you find that the City of Ionia has not provided
adequate accommodations for disability.
Instructions: Please complete this form and submit to the City Manager no later than 60
calendar days following the alleged violation. The ADA Coordinator will respond
to any grievances within 15 days.
Grievant Information
Name of Grievant: _______________________________________________________________
Person Preparing Grievance (If different): ____________________________________________
Address of Grievant: __________________________ City, State, Zip: ______________________
Phone: _____________________________________ Email: _____________________________
Date(s) the Incident Occurred: _____________________________________________________
Incident Details
Please provide a complete description of the specific complaint or grievance:
Please specify any location(s) related to the complaint or grievance (If applicable):
1
Created October 2021
Please state your suggested outcome for the resolution of your grievance:
Please attach any photos or other documentation of the complaint or grievance that you have.
Signature
Signature of Grievant: ____________________________________ Date: __________________
Grievances shall be submitted online or in writing to the City Manager:
Precia Garland
pgarland@ci.ionia.mi.us
P.O. Box 496
Ionia, MI 48846
Physical copies of this grievance form are available at City Hall. Upon request, reasonable
accommodations will be provided in completing this form. Contact the ADA Coordinator, Precia
Garland at (616) 527-5776 or via email for more information.
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Created October 2021
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