Fillable ADA Grievance/Complaint Form (State of Delaware)

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ADA Grievance/Complaint Form (State of Delaware)

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ADA Grievance/Complaint Form
If you have accessibility concerns or questions please fill out this form.
N
ame
Street Address
City State Zip Code
Phone
Email Address
Comments or Questions?
Grievance? Please provide a detailed description including date of incident.
Please provide complete address and/or location, if other than a roadway (e.g. rest area,
pedestrian bridge, etc.):
Please call DelDOT at 302-760-2048 with questions, or to seek assistance in filling out the
form, and/or mail form to:
DelDOT ADA Title II/Section 504 Coordinator
Att: Tom Nickel
P.O. Box 778
Dover, DE 19903
Email:
DOT.ADASupport@Delaware.gov
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ADA GrievanceComplaint Form (State of Delaware)

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Completed 27 January 2021

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