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American with Disabilities Act (ADA)/Title VI request and complaint form

  1. Please complete this form to request accommodations or to file a complaint with the City of Everett coordinator. Only fields with an asterisk (*) are required. All other fields are optional.

    This form is for public use only. City of Everett employees seeking accommodations should contact Human Resources.

  2. What is your preferred mode of contact?*
  3. Please tell us the type of accommodations you need. If it's an event, please include the date of the event. If it's a location, please tell us the address of the location. 

  4. I was discriminated against because of:
  5. Leave This Blank:

  6. This field is not part of the form submission.