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ADA Complaint Form

ADA Complaint Form

In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990 and Section 504 of the Rehabilitation Act of 1973, the City of Fort Collins (“City”) will not discriminate against qualified individuals with disabilities on the basis of disability in its provision of public facilities, services, programs or activities. 

If you feel you have been discriminated against on the basis of a disability through the City of Fort Collins’ provision of a public facility, service, program or activity (pursuant to the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973), please complete this ADA Complaint Form.    

Please complete all questions to the best of your knowledge. If you need assistance in completing this form, including sign language assistance, documents in Braille or other ways of making information and communications accessible,
please contact the City’s ADA Coordinator via email, at adacoordinator@fcgov.com, or by calling 970.416.4254. 
PLEASE RESPOND TO ALL QUESTIONS TO THE BEST OF YOUR KNOWLEDGE:
1. Complainant
2. Person discriminated against (if someone other than you, complainant)
3. Which City of Fort Collins' public facility, program, service or activity is the complaint about: (complete all that apply to this complaint, otherwise leave blank)
This question requires a valid date format of MM/DD/YYYY.
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7. Were there any witnesses to the incident?
Please provide as much information as possible about any witnesses.

Witness A:
Please provide as much information as possible about any witnesses.

Witness B:
8. Have any efforts been made to file or resolve this complaint through the internal grievance procedures of any City of Fort Collins department?
9. Have you filed a complaint about this same incident with any other agency or court?
If so, fill in the organization’s name and contact person:
Space Cell Organization NameContact Person
Federal Agency:
Federal Court:
State Agency:
State Court:
City or Local Agency:
City or Municipal Court:
Other - Please provide the full contact information for the person with the “other” agency or court: 
This question requires a valid date format of MM/DD/YYYY.
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This question requires a valid email address.
The City’s ADA Coordinator will notify you when your complaint has been received. If you do not receive confirmation within 2 weeks, please call or email the City’s ADA Coordinator at 970.416.4254 or adacoordinator@fcgov.com