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2. This form may be used by anyone who wishes to file a complaint alleging discrimination on the basis of disability in the provision of services, activities, programs, or benefits by the City of Glenwood Springs. The City's Personnel Policy governs employment-related complaints of disability discrimination. 

   The complaint should be in writing and contain information about the alleged discrimination such as name, address, phone number of complainant and location, date, and description of the problem. Alternative means of filing complaints, such as personal interviews or a tape recording of the complaint, will be made available for persons with disabilities upon request.

   The complaint should be submitted by the grievant and/or his/her designee as soon as possible but no later than 60 calendar days after the alleged violation.

   For alternative formats, questions or assistance, contact us via:

   • Email: ADAteam@cogs.us
   • Phone: 970-384-6441
4. Name of Grievant*
6. Person Preparing Complaint (if different from Grievant)
7. Relationship of Preparer to Grievant (if applicable)
9. Address of Grievant
11. City
12. State
13. Zip Code
15. Phone Number
16. Email Address
18. Nature of Grievance*

    Please provide a complete description of the specific complaint or grievance, including any incident, barrier, or perceived denial of benefit of any service, program, or activity.

20. Please specify any location(s) related to the complaint or grievance (if applicable).
22. Please state what you think should be done to resolve the complaint or grievance.
24. Supplemental Information or Documentation

    Optional

Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field