PLEASE complete each section of this form to the best of your ability. For assistance with this form, or for information about the program accessibility, please call (314) 835-6157 Voice or please use Relay Missouri 1-800-735-2966 TDD.
Please view the hyperlink to the Des Peres ADA Grievance procedure process and pdf form if you prefer to print out and mail in. Please view for full procedure information. *Adobe or Adobe Reader is required to view this link.
(Check all that apply)
Limit of 30 characters. Must be only letters.
Name of program, service, activity, park or facility involved:
Please describe in your own words the action(s) by an employee(s), the rules or policy, the service(s) or the condition of a park, area, facility or structure which you feel is discriminatory or unfair. It is not necessary to refer to laws, regulation, ordinances, or policies in your description.
PLEASE describe the actions, which you feel need to be taken to address the problem.
Must this problem be addressed before a program begins or an event occurs? PLEASE identify any date, which you feel is important to the problem.
The City may need to contact you to schedule a meeting to discuss your complaint. The meeting may occur within fifteen (15) calendar days from the date your inquiry is received.
Check two (2)
Please tell us a time that is more accommodating if none of the above times work.
This field is not part of the form submission.
* indicates a required field