City Forms

2. First Name*
3. Last Name*
5. Phone Number*
6. Email Address*
8. Preferred Contact Method*
   -- Select One --PhoneEmail
10. Nearest Address of Grievance/Barrier Location*

    Please include any cross streets, position, relative location to landmarks, etc.

12. Description of ADA Grievance or Barrier*

    General details of access barrier including concerns and how this affects daily activities.

14. Pictures (optional):

    Please provide a picture.

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16. 1. Receive an email copy of this form.
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