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This form is for City-run programs and activities, City services, and City-owned buildings.   For private businesses please submit a complaint through the City’s Q-Alert system or to the Department of Justice.  For discrimination by private employers, please contact the Equal Employment Opportunity Commission.  If you are a City of Warren employee, please submit your complaint or accomodation request through the City of Warren Employee Portal.

City of Warren ADA Complaint Resolution and Reasonable Accommodation Request

Name
How would you like to be contacted:
Address
I am submitting:
My complaint/accommodation request/allegation of discrimination or retaliation relates to:

Reasonable Accommodation

This accommodation is being requested because I (or the person submitting this form on my behalf) have a ADA-covered disability that prevents me from participating in the above-listed event.

Complaint

Disability-related discrimination or retaliation

Compliment/Suggestion/Question

Clear Signature
MM slash DD slash YYYY

This online form may also be printed and mailed or submitted in person to the City of Warren ADA Coordinator, c/o Warren City Attorney’s Office, One City Square, Suite 400, Warren, Michigan 48093.

Please direct any questions about this form to the ADA Coordinator by email adawarren@cityofwarren.org or by phone (586) 574-4671.