ADA Grievance

Americans with Disabilities Act

Complaint and Grievance Form for the 22nd District Agricultural Association
This grievance form may be used by any individual who wishes to file a complaint alleging discrimination on the basis of disability in employment practices and policies, or in the provision of services, programs or activities by the 22nd District Agricultural Association. Alternate means of filing a complaint are available upon request. This grievance must be submitted in writing by the complainant or his/her designee no later than 60 calendar days after the alleged violation. A separate grievance form should be completed for each alleged act of discrimination.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
I am a:*

Job Applicant22nd DAA EmployeePrivate Citizen
State the following for the alleged act of discrimination:

It is important for us to know how recently this incident happened so we can take the appropriate action. If this happened over a period of time or is still happening, please provide the most recent date.

Please tell us the city, state, and name of the location or office where this incident took place.
Date*

MonthDayYear
Date
Time
Location*
Describe the alleged act of discrimination.*
In your own words, describe what happened. Please include names of people involved, including witnesses if there are any.
If you require the District's response to this grievance be provided in alternate format (e.g. large print, Braille) please state your preferred response format below.
This grievance must be submitted in writing by the complainant or his/her designee no later than 60 calendar days after the alleged violation. Submit your grievance by pushing "Submit" below. You will receive a copy of your responses by email.

The ADA Coordinator or the responsible department will respond in writing within 30 calendar days to the complainant with a Plan of Action for resolving the complaint. The response will be provided in a format accessible to the complainant (e.g., large print, Braille or electronic version).

The response will include options for the substantive resolution of the complaint.
If the response received is not satisfactory to the complainant, the complainant or his/her designee may appeal the decision with 15 calendar days after receipt of the receipt of the response:

Chief Operating Officer
2260 Jimmy Durante Boulevard
Del Mar, CA 92014
Phone: (858) 755-1161
Fax: (858) 755-7820
TTY: (858) 792-4492
Email: customercare@sdfair.com
Should be Empty:

Americans with Disabilities Act