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The Process for ADA Assistance (State of New Hampshire)

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New Hampshire
Governor’s Commission on Disability
603.271.2773
www.nh.gov/disability
54 Regional Drive, Suite 5
Concord, NH 03301-8502
Christopher T. Sununu, Governor
Paul Van Blarigan, Chair
Charles J. Saia, Executive Director
The Process for ADA Assistance
The Governor’s Commission on Disability (“GCD”) was established to serve
as a source of information to the public regarding all services to persons with
a disability. The GCD does not provide individuals with legal advice. However,
if you are in need of assistance regarding the Americans with Disabilities Act
(“ADA”) and the rights protected thereunder, please feel free to contact us at
the telephone number, mailing address or email address below. We
encourage you to complete the attached Information Form to fully describe in
writing the events which you would like to discuss. Although we welcome your
calls, it may be easier for you to complete this form in advance so that we may
address your inquiry in an expeditious and thorough manner. Kindly submit
the Information Form to us via email or mail so that our staff may review the
details and respond.
The GCD does not accept any information from anonymous individuals.
You must completely fill out the Form with your name and the requested
information. After reviewing the Form, the GCD may call you for further
information. Filing a false form may result in a referral to the New
Hampshire Attorney General’s office or other entity for review and possible
legal action.
Email: disability@gcd.nh.gov
1-800-852-3405 (toll free in NH)
Or
603 271-2773
New Hampshire
Governor’s Commission on Disability
603.271.2773
www.nh.gov/disability
54 Regional Drive, Suite 5
Concord, NH 03301-8502
Christopher T. Sununu, Governor
Paul Van Blarigan, Chair
Charles J. Saia, Executive Director
INFORMATION FORM
(Page 1 of 2)
Please type or print neatly. Answer all questions as completely as possible.
A
ttach copi
es of all relevant documents to your Information Form.
*Required Information
*Name
*Mailing Address
*Telephone (Home) Best time to call
Work Telephone Email
*When did the incident occur? Date
* Name of business, individual, etc., that may have overlooked the ADA.
*Have you contacted
the business/individual, etc.? Yes No
*Have you contacted
any other agency? Yes No If so, provide the
agency name and address.
*Have you hired a Lawyer
? Yes No If so, provide lawyer’s name
and address.
May we contact
the business or individual? Yes No
603.271.2773
www.nh.gov/disability
54 Regional Drive, Suite 5
Concord, NH 03301-8502
New Hampshire
Governor’s Commission on Disability
Christopher T. Sununu, Governor
Paul Van Blarigan, Chair
Charles J. Saia, Executive Director
INFORMATION FORM
PLEASE PROVIDE A BRIEF DESCRIPTION
(Page 2 of 2)
Include the issues which you have experienced and what you think is a fair
solution. Attach additional pages if necessary. We may contact you if more
information is needed.
Please read before signing below:
In filing this Information Form I understand that the Governor’s Commission on
Disability (GCD) is not my private attorney but is a resource for referrals. I also
understand that if I have any questions concerning my legal
rights or responsibilities I should contact a private attorney. I have no
objection to the contents of this Form being forwarded to the business or
individual, who is the subject of my inquiry.
The above information is true and accurate to the best of my knowledge.
Date Signat
ure
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The Process for ADA Assistance (State of New Hampshire)

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Completed 28 January 2021

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