Tri River Transit Authority Ada Complaint Form
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3Tri River Transit Authority
ADA COMPLAINT FORM
If you have a complaint about the accessibility of our transit system or believe you have been
discriminated against because of your disability, you can use this form to file a complaint.
Please provide all facts and circumstances surrounding your issue or complaint so we can fully
investigate the incident.
Please mail or return this form to:
Executive Director
Tri River Transit Authority
PO Box 436 Hamlin, WV 25523
trtpaula@zoominternet.net
304-824-2944
1. Complainant’s name:
Address:
City:
State:
Zip Code:
Daytime telephone: (
)
E-mail address:
Do you prefer to be contacted via e-mail?
Yes
No
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2. Are you filing this complaint on your own behalf?
Yes If YES, please go to question 6.
No If NO, please go to question 3.
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3. Please provide your name and address.
Name of person filing complaint:
Address:
City:
State:
Zip Code:
Daytime telephone: (
)
E-mail address:
Do you prefer to be contacted via e-mail?
Yes
No
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☐
4. What is your relationship to the person for whom you are filing the complaint?
5. Please confirm that you have obtained the permission of the aggrieved party to file
a complaint on their behalf.
Yes, I have permission.
No, I do not have permission
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