Hemet, CA · Riverside County
ADA/Section 504 Grievance Form
This form lets a person report alleged discrimination under the ADA or Section 504 to the City of Hemet’s ADA/Section 504 Coordinator.
What this form is
Use this form to submit a grievance concerning alleged discrimination under the Americans with Disabilities Act or Section 504 of the Rehabilitation Act of 1973. It asks for the complainant’s and affected person’s contact information, details about the alleged discrimination, resolution efforts, and information about complaints filed or planned with other agencies or courts.
Who needs it
A person who wishes to report alleged discrimination to the City of Hemet’s ADA/Section 504 Coordinator can complete and return this form.
How to submit it
Return the completed form to the ADA/Section 504 Coordinator by email, fax, mail, or in person, using the contact information printed on the form.
About notarization
This document is signed without a notary; the form asks the complainant to sign and date it, and mentions no notarized or sworn attachment.
How to submit this form
- 1
Download The Form
Download the ADA/Section 504 Grievance Form.
- 2
Complete The Form
Provide the requested contact details, grievance information, resolution efforts, and information about other agency or court filings.
- 3
Sign And Date
Sign and date the completed form.
- 4
Return The Form
Return it to the ADA/Section 504 Coordinator by email, fax, mail, or in person using the contact information on the form.
Frequently asked questions
- What is the ADA/Section 504 Grievance Form for?
- It allows a person to report alleged discrimination under the Americans with Disabilities Act or Section 504 of the Rehabilitation Act of 1973 to Hemet’s coordinator.
- What information does the grievance form ask for?
- It asks for contact details, information about the alleged discrimination and when it occurred, efforts to resolve the complaint, and details about other agency or court filings.
- How do I submit the grievance form?
- Complete and sign the form, then return it to the ADA/Section 504 Coordinator by email, fax, mail, or in person using the contact information on the form.
- Do I need a notary for the ADA/Section 504 Grievance Form?
- No. The form is signed without a notary; the complainant signs and dates it, and the document mentions no notarized or sworn attachment.
Need something notarized?
This ADA/Section 504 Grievance Form doesn’t need a notary — but if you have another Hemet form that does, a commissioned online notary can help.