Title II of the Americans with Disabilities Act Complaint/Grievance Form Larimer County, Colorado Logo
  • Title II of the Americans with Disabilities Act Complaint/Grievance Form Larimer County, Colorado

  • Section 1: Name and Contact Info

  • Section 2: Complaint Information

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  • Section 3: Witness Information

  • First Witness

  • Second Witness

  • Section 4: Documentation / Evidence

  • Please provide any documentation and list a describe evidence that directly supports your specific claim. You may also attach photographs or other files in support of your claims.

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  • Note: Parent or Legal Guardian may sign on behalf of minor child. Legal Guardian, Power of Attorney or equivalent may sign on behalf of adult – documentation is required.

    By typing your name and submitting this form, you certify that to the best of your knowledge this information is true and correct.

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  • Completed On: {signedDate}

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