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ADA Grievance Form

    
    
    
    
    
    
    
    
    
Two letter standard state abbreviation
    
    
    
    
    
    
    
    
    
    
Date the alleged discriminatory act or decision occurred
    
    
Court location that is the subject of this grievance
    
    
Name of the court program or service involved that is the subject of this grievance
    
    
    
    
Describe the alleged discriminatory act or decision (please be specific)