ADA Complaint Form

CITY OF MCKINNEY, TEXAS
AMERICANS WITH DISABILITIES ACT COMPLAINT FORM
The purpose of this form is to file a complaint regarding facilities, programs, services or an alleged incident of discrimination related to the Americans with Disabilities Act. The City of McKinney has an internal procedure providing for the prompt review and resolution of accessibility complaints for any visitor to City programs or facilities, or concerning an employee applicant. If you need help completing any of the requested information, you may contact the ADA Coordinator: contact-adacompliance@mckinneytexas.org or 972-547-2694. All complaints related to alleged incidents must be filed within 180 days of the alleged incident.
Date submitted

MonthDayYear
Date
REQUESTOR'S CONTACT INFORMATION:
Name
Address
Telephone number
Email address
example@example.com
If the ADA complaint is being submitted for someone other than yourself, please name that individual and provide his/her contact information:
Name
Address
Telephone number
Email address
example@example.com
Your relationship to this person
Alleged incident: Please describe the circumstances and specific location that prompted this complaint. Please provide as many specific details as possible (park or facility name, street address, etc.)
What specific resolution are you requesting for the circumstances or specific location that prompted this complaint?
Future accessibility: Please describe an accommodation or accessibility improvement that would help provide greater access to this program or facility or would prevent future similar incidents.
Complainants Signature

Clear
Date

MonthDayYear
Date
Please submit this form/the information on this form to:

ADA Coordinator, Public Works, 3501 N. Central Expy., McKinney, Texas 75071 Or email: contact-adacompliance@mckinneytexas.org
Should be Empty:

CITY OF MCKINNEY, TEXAS

AMERICANS WITH DISABILITIES ACT COMPLAINT FORM

REQUESTOR'S CONTACT INFORMATION: