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ADA Grievance Form

  1. Instructions:
    Please complete the form and submit it within sixty (60) business days of any incident to the City of Gainesville's ADA Coordinator.
  2. Type of Grievance*
    Check all that apply.
  3. Space provided for explanation of other type of grievance.
  4. Contact Information of Reporting Individual
    Please complete the contact information for the reporting individual.
  5. Phone Number
  6. Email Address
  7. Contact Information of Authorized Representative
    Please complete the contact information for the authorized representative of reporting individual, if any.
  8. Details of Complaint/Incident
  9. Resolving Complaint*
    Have attempts been made to resolve the complaint through a City Department?
  10. If yes, please describe the efforts that have been made.
  11. What action do you want taken?
  12. Please upload photos or supporting documentation for your grievance.
  13. If you need assistance, require an accessible format, or have questions about this form, please contact the ADA Coordinator for the City of Gainesville.
  14. City of Gainesville, Attn: Leah Gore, ADA Coordinator 200 S Rusk Street Gainesville, Texas 76240
  15. Phone: (940) 668-4590 Fax: (940) 668-4588
  16. Email:
  17. Leave This Blank:

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