What does the ADA/Section 504 Grievance Form ask for?

It asks about the complainant, the person affected, the alleged discrimination and when it occurred, efforts to resolve the complaint, and other agency or court filings.

How do I submit the ADA/Section 504 Grievance Form?

Return the completed form to the ADA Coordinator by email, fax, mail, or in person. The form lists the coordinator’s email and mailing address.

East Palo Alto, CA · San Mateo County

No notary required

ADA/Section 504 Grievance Form

This form lets a person submit a grievance to East Palo Alto about alleged discrimination under the Americans with Disabilities Act or Section 504.

What this form is

Use this form to describe 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 details, information about the incident, a description of the alleged discrimination, efforts to resolve the complaint, and any filings with or plans to contact another agency or court.

Who needs it

A person who wishes to submit a grievance about alleged discrimination under the Americans with Disabilities Act or Section 504 can use this form.

How to submit it

Return the completed form to the ADA Coordinator at 1960 Tate Street, East Palo Alto, CA 94303, by email at [email protected], by fax, by mail, or in person.

About notarization

This form is signed and dated without a notary; it mentions no notarized or sworn attachment, so the complainant just signs and dates it.

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, incident information, description, and information about resolution efforts or other filings.
3
Review And Sign
Review your responses, then sign and date the form.
4
Submit To The City
Return it to the ADA Coordinator by email, fax, mail, or in person using the contact details on the form.

Frequently asked questions

What does the ADA/Section 504 Grievance Form ask for?: It asks about the complainant, the person affected, the alleged discrimination and when it occurred, efforts to resolve the complaint, and other agency or court filings.
Who can use this grievance form?: A person who wants to submit a grievance about alleged discrimination under the Americans with Disabilities Act or Section 504 can complete and return the form.
How do I submit the ADA/Section 504 Grievance Form?: Return the completed form to the ADA Coordinator by email, fax, mail, or in person. The form lists the coordinator’s email and mailing address.
Do I need a notary for the ADA/Section 504 Grievance Form?: No. The form is signed and dated without a notary; it mentions no notarized or sworn attachment, so the complainant just signs and dates it.

Need something notarized?

This ADA/Section 504 Grievance Form doesn’t need a notary — but if you have another East Palo Alto form that does, a commissioned online notary can help.