Tyler, TX · Smith County
ADA Title II Grievance Procedure Complaint Form
This form lets a person report an access concern involving a City of Tyler facility, program, or service related to a disability.
What this form is
Use this form to file a grievance if you believe a disability prevented you from accessing a City of Tyler facility, program, or service. It asks for your contact information, details about the accessibility issue and when it occurred, efforts to resolve it with staff, and your suggested resolution. You may submit a grievance by form, phone, fax, or email.
Who needs it
A person who believes they were denied access to a City of Tyler facility, program, or service because of a disability may file this complaint.
How to submit it
Send the form to Sharon Roberts, ADA Coordinator, City of Tyler Legal Department, P.O. Box 2039, Tyler, TX 75710. The document also lists phone, fax, and email as ways to file a grievance.
About notarization
This complaint form is signed and dated without a notary; it lists no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download The Form
Download the ADA Title II Grievance Procedure Complaint Form.
- 2
Complete The Form
Provide your contact information and describe the accessibility issue, when it occurred, and your suggested resolution.
- 3
Sign And Date
Sign and date the complaint form. The document lists no required attachments.
- 4
Submit To The City
Send the form to the ADA Coordinator at the address shown, or file by phone, fax, or email.
Frequently asked questions
- What is the ADA Title II Grievance Procedure Complaint Form?
- It is a City of Tyler form for reporting a concern that a disability prevented access to a city facility, program, or service.
- Who can file this complaint?
- A person who believes they were denied access to a City of Tyler facility, program, or service because of a disability can file a grievance.
- Do I need a notary for the ADA Title II Grievance Procedure Complaint Form?
- No. The form has a signature and date line but no notary block or notarized attachment; the signer just signs and dates it.
- How do I submit the ADA grievance complaint?
- Send the form to the ADA Coordinator at the City of Tyler Legal Department address shown on the form, or file by phone, fax, or email using its listed contact information.
Need something notarized?
This ADA Title II Grievance Procedure Complaint Form doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.