Click here to return to the E-Government Services start page
 
Welcome to the City of Muncie, IN, Action Line
Today is Wednesday, October 23, 2019.
WARNING! Please do not use this form to report issues of an emergency nature or for conditions requiring an immediate response. If your issue is an emergency, please use the telephone and dial 911.
ADA Grievance Form

PLEASE READ COMPLETELY BEFORE FILLING OUT FORM. THIS COMPLETED PRELIMINARY INFORMATION DOES NOT CONSTITUTE A COMPLAINT.

The Americans with Disabilities Act information packet (which includes a City of Muncie resolution, City responsibilities and procedures, and a form) can be downloaded by clicking here or by visiting the City of Muncie Human Rights webpage.
A formal complaint may be completed at a later date.




THIS INTAKE SURVEY WILL ALLOW US TO DETERMINE IF WE CAN TAKE YOUR COMPLAINT - PLEASE COMPLETE IT TO THE BEST OF YOUR ABILITY. IF YOU NEED ASSISTANCE, CONTACT US.

NOTICE OF CONFIDENTIALITY

The information contained in this communication from the Office of the City of Muncie Human Rights Commission is privileged and confidential, and is intended for the sole use of the person or entities who are the addressees. If you are not an intended recipient of this communication, the dissemination, distribution, copying, or use of the information it contains is strictly prohibited. If you have received this communication in error, please immediately contact the Commission at (765)747-4854 to arrange for the return of this information. Thank you.

* Information is required.

Contact Information

* First Name:
* Last Name:
Email:
* Daytime Phone: (
* Address:
* City:
* State:
* ZIP:

Individual Discriminated Against (if different than above)
 
Complainant Address, City, State, Zip (if different than above)
 
Complainant Phone Number (if different than above)
 
Alleged Violation - Date(s) & Approximate Time of Occurrence
 
Detailed Description of Violation and County Department/Location Involved
 
Requested Action by County to Correct Violation
 
Has Complaint been filed with State or Federal Agency


3
 
If Yes: Name of Agency, Date, Contact Person
 
List Witnesses - Names and Addresses separately, one line at a time
 

CAPTCHA

Check here to have email confirmation of this submission.

* Information is required.

Notes:

If you send us a message, you will receive a Tracking Number allowing you to follow-up with your request, at your convenience.

Internal Use Only, Leave Blank:
Please leave this field blank and remove any values that have been populated for it.

City Home | E-Gov Home | Action Line
Login | Register | Privacy Policy
Copyright ©2004-2019. Electronic Commerce Link, Inc. dba egovlink.