Form Center

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ADA Title II Grievance Form

  1. The City of Lenoir ADA Transition Plan is on the City website at

  2. This section to be completed only if the aggrieved person is not the individual completing this form.

  3. Have efforts been made to resolve this complaint through the Request for Accommodation with the ADA Coordinator?
  4. By typing my name, I am signing this form.

  5. ADA Coordinator

    Upon request, reasonable accommodation will be provided in completing this form or copies of the form. Please contact the ADA Compliance Coordinator.

    ADA Coordinator
    David Coffey
    Risk Manager/Purchasing Agent
    City of Lenoir
    801 West Ave NW
    Lenoir, NC 28645

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