Fate, TX · Rockwall County
Title II ADA Grievance Form
This form lets individuals report a disability-related grievance involving a City of Fate program, service, facility, or other city activity.
What this form is
Use this form to report a grievance involving a City of Fate program, service, facility, accommodation request, or other city activity. The form asks for the reporting individual’s contact information, incident date and location, complaint details, steps taken to resolve it, and the remedy sought. Complete and sign the form, then email or mail it to the ADA/504 Coordinator within 60 calendar days of the incident.
Who needs it
An individual reporting a grievance about a City of Fate program, service, facility, accommodation request, or other city activity can complete this form.
How to submit it
Email the completed, signed form to [email protected] or mail it to Steve Gilbert, ADA/504 Coordinator, 1900 C.D. Boren Parkway, Fate, TX 75087. The form says to submit it within 60 calendar days of the incident.
About notarization
This document is signed and dated without a notary; it asks for no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download the Form
Download the Title II ADA Grievance Form.
- 2
Complete the Form
Provide the requested contact information, incident details, resolution efforts, and remedy sought.
- 3
Gather Additional Pages
Attach additional pages if needed to explain the grievance.
- 4
Sign and Submit
Sign and date the form, then email or mail it to the ADA/504 Coordinator within 60 calendar days of the incident.
Frequently asked questions
- Do I need a notary for the Title II ADA Grievance Form?
- No. The form asks you to sign and date it, but it has no notary block and does not request a notarized or sworn attachment.
- How do I submit the Title II ADA Grievance Form?
- Email the completed, signed form to [email protected] or mail it to Steve Gilbert, ADA/504 Coordinator, 1900 C.D. Boren Parkway, Fate, TX 75087. Submit it within 60 calendar days of the incident.
- What information does the grievance form ask for?
- It asks for contact information, the incident date and location, a description of the complaint, efforts to resolve it through a city department, and the remedy sought.
Need something notarized?
This Title II ADA Grievance Form doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.