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State of Michigan ADA Title II Grievance Form

State of Michigan ADA Title II Grievance Form

If you believe you have been the subject of discrimination by a state government entity based on disability, or you are unable to access a state program, service or activity due to your disability, you can use the form on this page to report disability discrimination to the state of Michigan's ADA coordinators.

If you wish to report your concerns of discrimination in another format, please contact the appropriate State of Michigan ADA coordinator.

Please see the ADA complaint procedure page for full information about the process including timeline and next steps.

Print before submitting

Upon selecting the "Submit" button, the information from this form is transmitted electronically to the State of Michigan department or agency selected and the information is also cleared from the form.

Please use your browser's print functionality to print a copy of your completed form for your records, and to mail your appeal if you wish to submit the appeal using the United States Postal Service. The form must be printed BEFORE you select the Submit button.

All fields are required, unless labeled as (optional).

Section 1

This section is displayed because you selected "Yes" for the previous question.

Alternative contact's information

Section 2

Unless a contact method is provided (i.e. phone or email), the complainant will not be contacted about this complaint.

This section is displayed because you selected "None of the above" for the previous question.

This section is displayed because you selected "Other" for the previous question.

Section 3

This section is displayed because you selected "Other" for the previous question.

Location or Building Information

Section 4

This section is displayed because you selected "No" for the previous question.