GRIEVANCE PROCEDURE
UNDER THE AMERICANS WITH DISABILITIES ACT
Complaint Form
This Form may be used by any individual to file a complaint alleging discrimination on the basis
of disability in meetings, services, programs or activities of the City of Providence under Title II
of the ADA. Alternate means of filing a complaint, such as personal interviews or tape
recordings, are available upon request for people with disabilities. All complaints will be kept
on file for a minimum of 3 years.
Filing Date:_________________________ Date of Alleged Incident:______________________
Complainant Name:_____________________________________________________________
Home Address: ________________________________________________________________
Phone # :__________________________Email:______________________________________
The alleged act of discrimination involves which City department, meeting, agency or program?
______________________________________________________________________________
______________________________________________________________________________
Describe the alleged act of discrimination (additional paper may be attached):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
This Complaint Form (or alternate reporting method) should be submitted by the complainant or
his/her designee as soon as possible, but no later than 120 days after the alleged violation, to:
Leonela Felix, Esq.,
Ethics Education and ADA Coordinator
401-680-5333
lfelix@providenceri.gov
City Solicitor's Office
444 Westminster Street, Suite 220, Providence, RI 02903
401 680 5333 ph | 401 680 5520 fax
www.providenceri.gov