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ADA Grievance Form

  1. Complainant Name

  2. Complainant Address

  3. Preferred Method of Contact*

  4. Person or persons affected by the violation allegation, if different from Complainant.

  5. Tell us your concern.

  6. How can we fix your problem?

  7. Has the complaint been filed with another bureau of the Department of Justice or any other Federal, State, or local civil rights agency or court?*

  8. If the answer to the above question is yes, please provide a contact person and address below.

  9. If you have questions or issues with this form, please contact the City Clerk, Katie Nakazono at nakazonok@webstergroves.org or 314-963-5318.

  10. If you are printing this form, please return to:

    City Clerk #4 E. Lockwood Webster Groves, MO 63119

  11. Leave This Blank:

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