College of the Siskiyous
ADA Compliance Committee
Complaint Form
To better serve you and resolve your complaint or issue efficiently, please complete this form. Contact
information is to clarify any questions we may have regarding your issue, or to let you know how we
resolved the issue.
First Name: Last Name:
Phone Number: Can we leave a message? Yes No
Email:
Please select your most appropriate COS status:
Student Employee Community Member
Please select the area(s) of concern for this issue:
Technology Web Pages Classroom
Curriculum Facilities Other - please describe below
Briefly describe the issue:
Thank you! The ADA coordinator or designee will follow up with you within two business days from day
of submission.