Buellton, CA · Santa Barbara County
ADA Grievance Form
Buellton residents can use this form to submit a complaint about alleged discrimination under the Americans with Disabilities Act or Section 504.
What this form is
The ADA Grievance Form collects information about a complaint involving alleged discrimination under the Americans with Disabilities Act or Section 504 of the Rehabilitation Act. It asks for contact details, the person or department involved, when the discrimination occurred, a description of the alleged acts, and efforts to resolve the complaint. It also asks about complaints filed with or planned for other agencies or courts.
Who needs it
A person who believes they experienced discrimination under the Americans with Disabilities Act or Section 504 can complete and submit this grievance form.
How to submit it
Return the form to Linda Reid, City Clerk/H.R. Director/ADA Coordinator, by mail to P.O. Box 1819, Buellton, CA 93427, or by email to [email protected]. The instructions also say to submit it by fax or in person.
About notarization
This document is signed without a notary; the signer just signs and dates the grievance form.
How to submit this form
- 1
Download The Form
Download the ADA Grievance Form PDF.
- 2
Complete The Form
Provide your contact details, describe the alleged discrimination, and answer the questions about efforts to resolve the complaint.
- 3
Review Other Agency Details
Answer the questions about complaints filed with or planned for another agency or court, and add any comments or information.
- 4
Sign And Submit
Sign and date the form, then return it to Linda Reid by mail or email; the instructions also mention fax or in-person submission.
Frequently asked questions
- What is the ADA Grievance Form for?
- It lets a person describe alleged discrimination under the Americans with Disabilities Act or Section 504, provide details about the complaint, and report efforts to resolve it.
- Who should complete the form?
- A person who believes they experienced discrimination under the Americans with Disabilities Act or Section 504 can provide their contact information and details about the alleged acts.
- Do I need a notary for the ADA Grievance Form?
- No. This document is signed without a notary; the signer just signs and dates the grievance form.
- How do I submit the ADA Grievance Form?
- Return it to Linda Reid, City Clerk/H.R. Director/ADA Coordinator, by mail to P.O. Box 1819, Buellton, CA 93427, or email it to [email protected]. The instructions also mention fax or in-person submission.