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City of Corpus Christi


CITIZEN ACCESSIBILITY GRIEVANCE FORM


Person(s) Filing Grievance
First Name: Last Name:
Phone #:
Street Address: City:
State: Zip:
Description of Grievance
Business, organization or institution which you believe has discriminated:
Name:
Address:
Date of incident(s):
Please describe the accessibility complaint - Indicate inforamtion about the alleged discrimination, including but not limited to location(s) of problem(s), date of problem(s) and description of the problem(s):
Requested Resolution of Grievance
Please state what or how you feel the grievance may be resolved:
Designee or Person Authorized to File on Behalf of the Aggrieved Individual
Name:
Address:

Pressing the submit button will send the information entered to the Corpus Christi Human Relations Commission. Please verify that all the above information is correct before submitting. There will be no preview page.
If you are not contacted in 7 days, please call (361) 826-3190