ADA Complaint Form

Please note!

The Americans with Disabilities Act of 1990 (ADA) prohibits discrimination and ensures equal opportunity and access for persons with disabilities.

Any person who believes that they have been discriminated against by the city of Phoenix, or one of the city’s service providers, and believes that the discrimination is based solely upon their disability, may file a complaint with the city. Any such complaint must be in writing and filed within 180 days following the date of the alleged discriminatory occurrence.

To file a complaint online, please complete and then submit this form. It is pre-addressed to arrive at the correct destination when you click on the “Submit” button below.

If you have questions or comments about the process, or want to email the ADA/Title VI Coordinator directly, please use this email address: PHXTransitEO@phoenix.gov.

In order for us to respond to your message appropriately, please fill in as much of the following information as possible.

Please wait while your form is submitted.

*denotes required field

Incident Information *

Customer Information

First Name: *

Last Name: *

Middle Initial:

Address: *

City: *

State: *

Zip: *

Phone: *

Email: *

Advocate Information

Are you filling out this complaint on your own behalf? *

Incident Information

Time of Incident: * (Please enter in format: HH:MM AM/PM)

Date of Incident: * (Month, Date, Year; i.e. Jan. 1, 2019)

City Where Incident Occurred: *

Major Crossroads: *

Crossroad One:

Crossroad Two:

Direction of Travel: *

Service Type: *

Route and/or Vehicle Number:

Operator and Vehicle Information:

Operator Name and/or Description:

Vehicle Number and/or Description:

Complaint Details

Please describe the incident and provide details about why you believe you were discriminated against. Please describe all persons involved in the incident, including the name(s) and contact information of the person(s) who discriminated against you, and names and contact information of any witnesses. *

Additional Complaint Information

Have you filed a complaint about this incident with the Federal Transit Administration (FTA) or Valley Metro? *
Yes (Please enter details about the complaint(s) below.)
No

If yes, please provide details: (complaint number(s), or contact(s) at either agency):

Attachments

Please attach any additional material that is relevant to your complaint.

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Electronic Signature *

Signature: *

Please enter your full legal name above. This will be considered your signature.

ADA Complaint Form

Incident Information *

Customer Information

Advocate Information

Incident Information

Major Crossroads: *

Complaint Details

Additional Complaint Information

Attachments

Please attach any additional material that is relevant to your complaint.

The combined size of all uploaded files is limited to 20MB.

Electronic Signature *

Review

Thank you for your submission!

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