ADA grievance form

Form Section 1

The county has developed a grievance procedure to ensure that accessibility concerns are resolved quickly and fairly, as outlined in the Americans with Disabilities Act (ADA).

Fill out the form and submit. If you have issues with the form, or want to file an oral grievance, call 612-348-7741.

ADA Coordinator

Amy.Mandell@hennepin.us

612-348-2692

Share your accessibility concerns

Person filing grievance

Name

Date

Address

City

State

Zip

Enter your email address

Please confirm your email address

Primary phone number

Is the person claiming the accessibility issue the same as the person filing the grievance?

Yes

Person claiming accessibility issue

Name

Address

City

State

Zip

Primary phone number

Please confirm your email address

Issue

Description of issue (e.g. crosswalk, website, building concerns) and remedy sought

Has this complaint been filed with another agency?

Yes

Other agency information

Agency or court

Complainant name

Address

City

State

Zip

Primary phone number

Date filed