ADA Grievance Form

ADA Grievance Form
Purpose:

The Americans with Disabilities Act, enacted on July 26, 1990, provides certain rights and protections from discrimination to Americans who are disabled, within the definition provided by the Act. The Act, known as ADA, also provides procedures for grievances based upon the rights which are protected by the ADA. This form is to be used if you wish to file a grievance against Johnson County, Kansas, its departments or agencies, or an employee, agent, or officer of the County.

Contact Person:

ADA Coordinator
Johnson County, County Manager Office
111 S. Cherry St., Olathe, KS 66061

Phone: (913) 715-0725

Assistance:

For help with this form or for alternative ways to file your complaint (tape recording, personal interview, etc.), please contact the ADA Coordinator at the address/phone number listed above.
Information Needed:
Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please tell us how we may contact you other than by mail.
Email:
example@example.com
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Please tell us what problem you have encountered at Johnson County regarding your rights under ADA. Please give as much detail as you can, including whom you have talked to, when the problem occurred, etc.*
Please tell us what accommodation or result you are requesting. *
Should be Empty:

Information Needed: