Kearny, AZ · Pinal County
Americans With Disabilities Act Section 504 Grievance Form
This form lets a person file a disability discrimination grievance with the Town of Kearny and describe the incident and any steps taken to resolve it.
What this form is
Use this form to submit a grievance about alleged discrimination under the Americans With Disabilities Act or Section 504 of the Rehabilitation Act of 1973. It asks for the complainant’s contact information, details about the person or department involved, when and how the discrimination occurred, and efforts to resolve the complaint. It also asks about complaints filed or planned with other agencies or courts.
Who needs it
A person who wants to report alleged disability discrimination involving the Town of Kearny can complete and return this grievance form.
How to submit it
Sign and return the completed form to the Town Manager at 912-C Tilbury Drive, Kearny, AZ 85137, by email to [email protected], fax to 520.363.7527, by mail, or in person.
About notarization
This grievance form is signed and dated without a notary; it requests no notarized attachment or sworn statement.
How to submit this form
- 1
Download The Form
Download the Town of Kearny ADA Section 504 Grievance Form.
- 2
Complete The Form
Provide your contact details, describe the alleged discrimination, and answer the questions about resolution efforts and other agencies or courts.
- 3
Gather Relevant Information
Have the incident details and any information about related complaints or resolution efforts ready to include.
- 4
Sign And Submit
Sign and date the form, then return it to the Town Manager by email, fax, mail, or in person.
Frequently asked questions
- What is the Kearny ADA Section 504 Grievance Form for?
- It lets a person submit a grievance about alleged disability discrimination and provide incident details, contact information, and any steps taken to resolve the complaint.
- Who can file this grievance form?
- A person reporting alleged disability discrimination can complete the form. It also has fields for the person discriminated against if someone other than the complainant is filing.
- Do I need a notary for the Kearny grievance form?
- No. The form asks for a signature and date but has no notary block; it requests no notarized attachment or sworn statement.
- How do I submit the Kearny grievance form?
- Sign and return it to the Town Manager by email, fax, mail, or in person using the contact details listed on the form.