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City of West St. Paul ADA Grievance

  1. Complainant Information

  2. Information of Person Discriminated Against (complete only if different from the complainant)

  3. Government, or organization or institution which you believe has discriminated:

  4. Have efforts been made to resolve this complaint?

  5. Has the complaint been filed with the Department of Justice or any other Federal, State, or local civil rights agency or court?

  6. If yes:

  7. Do you intend to file with another agency?

  8. If yes:

  9. By entering your name in this box, you agree all information provided in this form is correct to the best of your knowledge. This field acts as an electronic signature.

  10. Leave This Blank:

  11. This field is not part of the form submission.