Grievance Intake Form
If you have submitted a Service Request Form and feel the City of Walla Walla has not made a reasonable effort to accommodate you, you may submit the Grievance Intake Form. The City of Walla Walla has established a Grievance Procedure. If you need reasonable accommodation to fill out the Grievance Intake Form, please contact the City of Walla Walla ADA Coordinator at 509.527.4540 or TTY (7-1-1) or at ada-titlevi@wallawallawa.gov.
Contact Information
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Would you prefer contact by phone or email?
*
Phone
Email
Service Request Information
Location of Issue
*
Street Address
City
State / Province
Postal / Zip Code
Date of Observation:
-
Month
-
Day
Year
Date
Date of Service Request
-
Month
-
Day
Year
Date
Grievance Information
Grievance Information
*
Please include any additional information or comments regarding your grievance.
Signature
*
Submit
Should be Empty: