SEMCOG ADA Complaint Form

SEMCOG is committed to ensuring that no person is denied access to its services, programs, or activities on the basis of their disabilities, as provided by Title II of the Americans with Disabilities Act (ADA) of 1990 and Section 504 of the Rehabilitation Act of 1973.

Any person(s) or organization(s) believing they have been a victim of discrimination based on a disability may file a complaint by completing the form below or by contacting SEMCOG’s ADA Coordinator, Nick Friedrich by phone at (313) 961-4266 or via email at infocenter@semcog.org.

This complaint form can be provided in an alternative format upon request.

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First name (Required.)

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Last name: (Required.)

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Address (Required.)

Street address

Unit (if applicable)

City

State

Zip code

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Your phone number: (Required.)

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Your email address: (Required.)

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Date of complaint/incident (Required.)

Month/Day/Year

Date

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Location of complaint/incident (Required.)

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Are you filing this complaint on your own behalf? (Required.)

Yes

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Description of complaint/incident (please describe what happened and why you believe you were discriminated against. If known, please include the contact information and/or names of the person(s) who discriminated against you, as well as any witnesses) (Required.)

SEMCOG ADA Complaint Form

Question Title

* First name (Required.)

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* Last name: (Required.)

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* Address (Required.)

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* Your phone number: (Required.)

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* Your email address: (Required.)

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* Date of complaint/incident (Required.)

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* Location of complaint/incident (Required.)

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* Are you filing this complaint on your own behalf? (Required.)

Question Title

* Description of complaint/incident (please describe what happened and why you believe you were discriminated against. If known, please include the contact information and/or names of the person(s) who discriminated against you, as well as any witnesses) (Required.)

First name (Required.)

Last name: (Required.)

Address (Required.)

Your phone number: (Required.)

Your email address: (Required.)

Date of complaint/incident (Required.)

Location of complaint/incident (Required.)

Are you filing this complaint on your own behalf? (Required.)

Description of complaint/incident (please describe what happened and why you believe you were discriminated against. If known, please include the contact information and/or names of the person(s) who discriminated against you, as well as any witnesses) (Required.)