Complaint Form—Title II of The Americans with Disabilities Act

Downloadable Forms

Below are links to printable versions of the ADA Complaint Form. Complete the forms either in black ink or type. Sign and return to:

John Bryan, Office of ADA Coordinator
111 West Chesapeake Avenue, Room 120
Towson, Maryland 21204

ADA Complaint Form (Word)
ADA Complaint Form (PDF)

Online Form

Complete the form then select the "Submit" button to begin the complaint process.

Fields marked with >> are required.

Complainant Information

Complainant >>

Address >>

Telephone >>

Email >>

If your complaint involves a specific event, when did the incident occur?

Describe in detail the event or situation for which you are seeking ADA relief. Provide names, if appropriate, of individuals who were involved.

If this is a general request for an accommodation, describe the functional limitations caused by your disability for which you are requesting this accommodation.

Describe any accommodations that you believe would minimize or eliminate the barriers to your participation in the County’s services, activities, programs, or benefits:

I will need an accommodation to meet with the ADA Coordinator >>

Yes No

If “yes,” the accommodation I will need is:

Signature or Initials >>

Date >>