Hawaiian Gardens, CA · Los Angeles County
Grievance Form
This form lets a person report alleged disability discrimination involving the City of Hawaiian Gardens under the ADA or Section 504.
What this form is
The City of Hawaiian Gardens grievance form is for reporting alleged discrimination under the Americans with Disabilities Act or Section 504 of the Rehabilitation Act. It asks for contact details, information about the person or department involved, when and where the incident occurred, a description of the alleged acts, and any 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 file a grievance about alleged disability discrimination involving the City can complete and return this form.
How to submit it
Return the completed form by email, fax, mail, or in person to Chris Kelley, PE, ADA/504 Coordinator, at 21815 Pioneer Boulevard, Hawaiian Gardens, CA 90716, or [email protected].
About notarization
This grievance form is signed and dated without a notary; the document lists no notarized or sworn attachment.
How to submit this form
- 1
Download The Form
Download the City of Hawaiian Gardens Grievance Form.
- 2
Complete The Form
Fill in the requested contact details, incident information, resolution efforts, and other agency or court information, if applicable.
- 3
Gather Requested Details
Provide the names, dates, locations, and other information requested; the form does not specify attachments.
- 4
Submit To The City
Return the signed and dated form by email, fax, mail, or in person to the ADA/504 Coordinator.
Frequently asked questions
- What is the Hawaiian Gardens Grievance Form for?
- It lets a person report alleged disability discrimination involving the city under the ADA or Section 504 and provide details about the incident.
- Who should complete this grievance form?
- A person who wants to report alleged disability discrimination involving the City of Hawaiian Gardens can fill out the form and return it to the listed coordinator.
- Do I need a notary for the Grievance Form?
- No. The form asks for a signature and date, but does not require notarization or identify a sworn or notarized attachment.
- How do I submit the Grievance Form?
- Return it by email, fax, mail, or in person to the ADA/504 Coordinator. The form lists an email address and mailing address, but no fax number.
Need something notarized?
This Grievance Form doesn’t need a notary — but if you have another Hawaiian Gardens form that does, a commissioned online notary can help.