Ada Complaint Form - Asheville printable pdf download

Ada Complaint Form - Asheville

Attachment A

ADA Complaint Form

City of Asheville

Transit Services

Do you think you have been discriminated against or excluded or denied service by the

ART (Asheville Redefines Transit), Apple Country Transit or Mountain Mobility due to a

disability?

The City of Asheville is committed to ensuring that no qualified individual with a disability

shall, by reason of such disability, be excluded from the participation in, be denied the benefits

of, or be subjected to discrimination by a the City of Asheville, its contractors nor sub recipients

(Americans With Disabilities Act of 1990).

Complaints under the ADA law must be filed within 180 days from the date of the alleged

discrimination. Please complete the information below to file your complaint. If you need help

completing this form, call the City of Asheville Transportation Department at (828) 232-4531

or email iride@ashevillenc.gov. As a complainant, if you are not provided, please request a

copy of the Process and Procedures for Addressing American with Disabilities Act Complaints,.

Your Name:_______________________ Street Address ______________________

City, State & Zip Code: _________________________________________________

Phone number: ___________________Other phone: _________________________

Who was discriminated against? (Please circle) You?

Someone Else?

If someone else, their:

Name(s): _______________________Street Address _________________________

City State & Zip Code:___________________________________________________

Date of Incident: _____________________________________________________

Please describe the alleged discrimination incident. If possible, provide the names and titles of all

City Of Asheville transit employees involved. Explained what happened and who you believe

was responsible. Please use the back of this form if additional space is required.

_____

_______________________________________________________________________

__________________________________________________________

_________________________________________________________

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Ada Complaint Form - Asheville