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State of Michigan ADA Complaint Form

Caution: Please remember to save and/or print your completed appeal form before using the Submit button.

Note: When you use the Submit button the information is transmitted electronically to the State of Michigan department or agency selected, and at the same time the information is cleared from the form.

Please use your browser's 'Save as' functionality to save a copy of your completed form for your records.

Please use your browser's 'Print' functionality to print a copy of your completed form for your records and/or to mail your appeal if you wish to submit the appeal using the United States Postal Service.

All fields are required unless labeled optional.