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ADA Compliance Grievance Complaint Form

  1. The City of Irving will make every effort to ensure that confidentiality is maintained throughout the complaint process. This means the city will share any sensitive information provided below on a need-to-know basis.

  2. I require Texas Relay Service 711 (TTY) *

  3. Preferred Method(s) of Communication*

    Check all that apply

  4. Be specific, and give date(s), time(s) and location(s).

  5. List the names of (or describe) all persons in your complaint. Indicate job title, department or division, when possible.

  6. List the names of (or describe) all persons in your complaint. Indicate job title, department or division, when possible.

  7. What remedies or solutions are seeking?

  8. Certification

  9. Leave This Blank:

  10. This field is not part of the form submission.