Accessibility Complaint Form

Name of Complainant *

Email *

Address

City

State WisconsinAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew_HampshireNew_JerseyNew_MexicoNew_YorkNorth_CarolinaNorth_DakotaOhioOklahomaOregonPennsylvaniaRhode_IslandSouth_CarolinaSouth_DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest_VirginiaWyoming

Zip Code

Daytime or Cell Phone

Preferred Method(s) of Communication (Select all that apply) *
To select multiple options, hold down the Shift key as you click one or more listed option.
Voice Telephone711 (TTY) Wisconsin Relay ServiceEmailUS MailOther (Please explain below)

If you selected "Other" as your preferred method of communication, in the previous question, please describe your preferred method(s) of communication in detail:

Type of Accessibility Complaint *
To select multiple options, hold down the Shift key as you click one or more listed option.
Architectural AccessPublic Right-of WayPrograms/Services/Activities

Name of City of Milwaukee Facility, Program/Services/Activity and/or Street/Traffic *

Specific Location *

Description of Accessibility Complaint *

Date of Complaint (Enter as MM/DD/YYYY) *

The ADA Coordinator will provide a copy of this complaint to the appropriate city department to conduct an investigation.  The responsible department will report the results of their investigation and include a solution with time frame to the ADA Coordinator.  The complainant should receive a written response from the ADA Coordinator within 30 business days.  If you do not, please contact the ADA Coordinator at:

Rebecca Rabatin, ADA Coordinator

City of Milwaukee
Department of Administration
Budget and Management Division
200 East Wells Street, Room 603
Milwaukee, WI 53202

Phone: (414) 286-3475
TTY: 711
Fax: (414) 286-5475
Email: [email protected]

If you wish to print and send in the form, you may download a printable Complaint Form.