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City of Lodi ADA Complaint Form (Electronic)
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This form has been modified since it was saved. Please review all fields before submitting.
Complainant First Name:
Complainant Last Name:
Person Preparing Complaint (if different from Complainant)
Relationship to Complainant (if different from Complainant)
Please provide a complete description of the specific complaint or grievance:
Please specify any location(s) related to the complaint or grievance (if applicable):
Please state what you think should be done to resolve the complaint or grievance:
Please attach additional images or information as needed.
Upon request, assistance can be provided in completing this form, or copies of the form will be provided in alternative formats. Contact the ADA / Section 504 Coordinator, via telephone (209) 333-6711 or via Telecommunication Relay Service (TRS) by dialing 7-1-1, or via e-mail at email@example.com, or at the following address: Jennifer Rhyne, City of Lodi ADA / Section 504 Coordinator, PO Box 3006, 221 W. Pine Street, Lodi, CA 95240.
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