ADA Grievance Form

Reporting Individual
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Authorized Representative of Reporting Individual
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Detail of Violation
Type of Grievance (check all that apply)
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I certify under penalty of perjury, that the foregoing statements are true. I further acknowledge that by typing my initials below I intend to fully sign this document.
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Upload additional information as necessary. If you need assistance, require an accessible format, or have questions about this form please contact the Kenai Peninsula Borough ADA Coordinator at jblankenship@kpb.us or 907-714-2160.

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