Lakewood, WA · Pierce County
ADA Grievance Form
Individuals or their authorized representatives use this form to report an alleged access violation or discrimination based on disability to the City of Lakewood.
What this form is
The ADA Grievance Form lets an individual or authorized representative report an alleged City access violation or discrimination based on disability. It asks for contact details, incident dates and locations, information about employees and witnesses, and the action requested. The form also provides space for additional information and a signature.
Who needs it
Individuals reporting an alleged City access violation or disability discrimination, and representatives filing on their behalf, can use this form.
How to submit it
Submit the form to the appropriate department head or to Mary McDougal, the City ADA Coordinator. It does not list an address, email, portal, or fee.
About notarization
This form is signed without a notary; the signer enters a name as a signature and dates the form.
How to submit this form
- 1
Download The Form
Download the City of Lakewood ADA Grievance Form.
- 2
Complete The Form
Describe the alleged violation or discrimination, incident details, relevant people, and the action you want taken.
- 3
Add Relevant Information
Provide witness, location, and grievant details if known. Add pages if needed to describe the grievance.
- 4
Sign And Submit
Sign and date the form, then submit it to the appropriate department head or the City ADA Coordinator.
Frequently asked questions
- Do I need a notary for the ADA Grievance Form?
- No. The form does not require a notary; it says entering the signer’s name is an acceptable signature, and it provides a place to date the form.
- How do I submit the ADA Grievance Form?
- Submit the completed form to the appropriate department head or to Mary McDougal, the City ADA Coordinator. The form does not provide an address, email, or portal.
- What information does the ADA Grievance Form ask for?
- It asks for contact information, details and dates of the alleged incident, locations, any involved City employees, witnesses, grievants, and the action requested.
- Can a representative file the ADA Grievance Form?
- Yes. The form includes fields for an authorized representative and asks for information about the person represented. It also allows a complaint to be filed on behalf of a group.