2. Use this form to report a complaint of ADA Title II non-compliance. Please use one form per complaint.
6. Date:*
   Date:
8. Please provide your contact information:
10. First Name*
11. Last Name*
13. Address1:*
15. Address2:
17. City:*
18. State:*
19. Zip:*
21. Phone Number (day)*
22. Phone Number (evening):*
23. Email:
25. Preferred Method of Contact:
27. Please describe the problem you encountered:
29. Date of alleged violation*
    Date of alleged violation
31. Location of problem:*
33. Please provide, where possible, the names of any individuals at the City of Creve Coeur involved in the problem you encountered:
35. What change would you wish to see that would be helpful in solving this problem?*
37. To include more information, please attach separate sheet(s) of paper as necessary. Or attach a file (in Microsoft Word or Adobe PDF format) below.
39. Attach file of additional information, if needed.
41. Please submit the completed form by clicking on "Submit" below. Form can also be submitted:
43. By Mail
    ADA Title II Coordinator, 300 North New Ballas Road, Creve Coeur, MO 63141
44. By Email
    ADA Title II Coordinator
45. By Fax
    (314) 872-2539
47. Your complaint will be addressed within 30 business days.
    Accessibility Page

    For more information about completing and submitting this form or about the Complaint Process, please visit our Accessibility page.
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit Submit and Print

* indicates a required field