Form Center

2. City of Sultan - ADA Grievance Form
4. Complainant First Name
5. Complainant Last Name
7. Designee Preparing Grievance (if different from Complainant)
9. Designee's Relationship to Complainant
11. Address
13. City
14. State
15. Zip Code
17. Phone Number
18. Email Address
20. Preferred Contact Method

    1. Phone

    1. Email

    1. By Mail

    1. Please do not contact me personally
24. Please provide a complete description of the specific grievance
26. Please specify any location(s) related to the grievance (if applicable)
28. Please state what you think should be done to resolve the grievance
30. Please attach additional pages as needed

32. Return to: City of Sultan, Tami Pevey, ADA Coordinator/City Clerk, 319 Main Street, P.O. Box 1199, Sultan, WA 98294, or email to adacoordinator@ci.sultan.wa.us.

    Upon request, reasonable accommodation will be provided in completing this form, or copies of the form will be provided in alternative formats. Contact Tami Pevey, ADA Coordinator/City Clerk, 319 Main Street, P.O. Box 1199, Sultan, WA 98294, or email adacoordinator@ci.sultan.wa.us, or call 36-793-1811 (dial -7-1-1 for Washington State Relay Services).

Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field