MDCH - TITLE II - ADA Complaints

Skip Navigation

Michigan.gov, Official Website for the State of Michigan

Michigan.gov Home

MDCH Home | Sitemap | Contact MDCH

Birth, Death, Marriage and Divorce Records

Physical Health & Prevention

Pregnant Women, Children & Families

Mental Health & Substance Abuse

Health Care Coverage

Statistics and Reports

Providers

Inside Community Health

Public Safety & Environmental Health

Printer Friendly Text Only Version

Text Version

Share this link:

TITLE II - ADA Complaints

Title II of the ADA protects qualified individuals with disabilities from discrimination on the basis of disability in the services, programs, or activities of state government.

All Title II governmental agencies or entities are required to post notice informing the public of its ADA responsibilities.

"A public entity shall make available to applicants, participants, beneficiaries, and other interested persons information regarding the provisions of this part and its applicability to the services, programs, or activities of the public entity, and make such information available to them in such manner as the head of the entity finds necessary to apprise such persons of the protections against discrimination assured them by the Act and this part" 28 CFR Section 35.106.

If you wish to file a Title II ADA Complaint, please complete the ADA Complaint form as instructed. A department representative will contact you regarding your Complaint.

Instructions for filing a complaint

Complainant Information

Name:
Address:
City, State, ZIP:
Home & Business Telephone:

Person Making Complaint: If other than the complainant

Name:
Address:
City, State, ZIP:
Home & Business Telephone:

Department or Agency You Believe Has Discriminated

Department Name:
Department Address:
County:
City, State, ZIP:
Telephone:

Event Details

Date Event Occurred:

Describe the event, providing names, where possible, for the individuals who were involved.

Has the complaint been filed with the Michigan Department of Civil Rights, the Federal Department of Justice, or any other Federal Agency or Court?
Yes No

If YES, Please Complete the Following:

Agency or Court:
Contact Person:
Address:
City, State, ZIP:
Telephone Number:
Date Filed:
Do you intend to file with another agency or court? Yes No
Agency or Court:
Address:
City, State, ZIP:
Telephone Number:

Additional Comments

Date: