Who can file this Kane County ADA complaint form?

Anyone alleging disability discrimination in Kane County services, activities, programs, or benefits may file. A grievant may submit the complaint personally or through a designee.

What information does the complaint form ask for?

It asks for contact details for the complainant and, if different, the person discriminated against; information about the person or office involved; a description of the alleged discrimination; and details about resolution efforts and other complaints.

Do I need a notary for the Kane County ADA complaint form?

No. The form calls for a signature and date, but does not require a notary or specify a notarized or sworn attachment.

Kane County, IL · Kane County

No notary required

Americans With Disabilities Act Complaint Form

Kane County residents may use this form to file a complaint alleging disability discrimination in county services, activities, programs, or benefits.

At a glance

Issued by: City of Kane County · Kane County, Kane County, Illinois
Notarization: Not required: file this form without a notary.
Official source: kanecountyil.gov
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

This form lets a person report alleged disability discrimination in Kane County services, activities, programs, or benefits. The complaint should be submitted as soon as possible and no later than 60 calendar days after the alleged violation. It asks for contact details, information about the alleged discrimination, efforts to resolve it, and whether another agency or court has been contacted.

Who needs it

Anyone alleging disability discrimination in Kane County services, activities, programs, or benefits may file this complaint, personally or through a designee.

How to submit it

Sign and return the form to Jamie Lobrillo, ADA Coordinator, Kane County Department of Human Resource Management, 719 S. Batavia Avenue, Building A, Geneva, IL 60134. The form also lists [email protected].

About notarization

This complaint form is signed and dated without a notary; no notarized or sworn attachment is specified.

How to submit this form

1
Download the Form
Download the Kane County Americans With Disabilities Act Complaint Form.
2
Complete the Form
Provide the requested contact information, describe the alleged discrimination, and answer the questions about resolution efforts and other complaints.
3
Sign and Date
Sign and date the completed complaint form.
4
Return the Form
Send it to the ADA Coordinator at the Kane County Department of Human Resource Management at the address listed on the form.

Frequently asked questions

Who can file this Kane County ADA complaint form?: Anyone alleging disability discrimination in Kane County services, activities, programs, or benefits may file. A grievant may submit the complaint personally or through a designee.
What information does the complaint form ask for?: It asks for contact details for the complainant and, if different, the person discriminated against; information about the person or office involved; a description of the alleged discrimination; and details about resolution efforts and other complaints.
How do I submit the Kane County ADA complaint form?: Sign and return it to the ADA Coordinator at the Kane County Department of Human Resource Management, 719 S. Batavia Avenue, Building A, Geneva, IL 60134. The form also lists an email address.
Do I need a notary for the Kane County ADA complaint form?: No. The form calls for a signature and date, but does not require a notary or specify a notarized or sworn attachment.

Need something notarized?

This Americans With Disabilities Act Complaint Form doesn’t need a notary, but Illinois residents can notarize other documents online with a commissioned online notary.