Mason, MI · Ingham County
Title II, Section 504 Complaint
The Section 504 Complaint Form lets people report suspected disability discrimination by the City of Mason or its representatives.
What this form is
Use this form to report suspected Section 504 violations by the City of Mason or its employees, agents, contractors, subcontractors, or federal-fund subrecipients. The policy says grievances must be filed within 60 days of the alleged discrimination. The form asks for complainant contact details, dates and details of the alleged conduct, the remedy sought, and a signed certification.
Who needs it
People who believe they experienced disability discrimination by the City of Mason or a covered representative may use this form to file a complaint.
How to submit it
Mail the grievance to Sarah Jarvis, Section 504 Coordinator, City of Mason, 201 West Ash, Mason, MI 48854-0370, or contact her at 517.676.9155 or [email protected].
About notarization
This document is signed without a notary; the complainant signs and dates the certification, and no notarized or sworn attachment is specified.
How to submit this form
- 1
Download The Form
Download the Section 504 Complaint Form PDF.
- 2
Complete The Form
Provide your contact details, dates, complaint details, and the remedy sought; sign and date the certification.
- 3
Gather Supporting Information
The policy says supporting documentation should be included if possible; use additional sheets for complaint details as needed.
- 4
Submit The Grievance
Mail it to Sarah Jarvis, Section 504 Coordinator, at the City of Mason address listed in the policy.
Frequently asked questions
- What is the Section 504 Complaint Form for?
- It is used to report suspected Section 504 violations by the City of Mason or its employees, agents, contractors, subcontractors, or federal-fund subrecipients.
- Do I need a notary for the Section 504 Complaint Form?
- No. The complainant signs and dates the certification; the document does not specify a notarized or sworn attachment.
- How do I submit the Section 504 Complaint Form?
- Mail the grievance to Sarah Jarvis, Section 504 Coordinator, City of Mason, 201 West Ash, Mason, MI 48854-0370. The document also lists her phone number and email.
- What information does the complaint form ask for?
- It asks for contact details, dates related to the alleged discrimination, the name and title of the person involved if known, details of the complaint, the remedy sought, and a signed certification.