2. The complaint should be in writing and contain information about the alleged discrimination such as name, address, phone number of complainant and location, date, and description of the problem. Alternative means of filing complaints, such as personal interviews or a tape recording of the complaint will be made available for persons with disabilities upon request.

   This Grievance Procedure is established to meet the requirements of the Americans with Disabilities Act of 1990 ("ADA"). It may be used by anyone who wishes to file a complaint alleging discrimination on the basis of disability in the provision of services, activities, programs, or benefits by the City of Shreveport. The State of Louisiana, City of Shreveport, and Caddo Parish’s Personnel Policy governs employment-related complaints of disability discrimination. The complaint should be in writing and contain information about the alleged discrimination such as name, address, phone number of complainant and location, date, and description of the problem. Alternative means of filing complaints, such as personal interviews or a tape recording of the complaint will be made available for persons with disabilities upon request. The complaint should be submitted by the grievant and/or his/her designee as soon as possible but no later than 60 calendar days after the alleged violation 

4. Please complete information below to assist us with addressing your Grievance Complaint of Discrimination
6. Date of Discriminatory Acts
   Date of Discriminatory Acts

   Date of Discriminatory Acts
7. TYPE OF GRIEVANCE*
   -- Select One --PROGRAMSSERVICESACTIVITIESFACILITIESEMPLOYMENTSPORTRAN - PARATRANSIT / ON-DEMAND SERVICESSPORTRAN / FIXED-LINE SERVICECITY INFRASTRUCTURE

   Please select (1) of the options below

8. What protected disability is preventing participating in Program, Service, Activity, Facility, Paratransit, Navigating Public Infrastructure
10. Complaints that a city program, service, facility, activity and/or paratransit is not accessible to persons with disabilities should be directed to: ADA Coordinator | Attn: Alonzo Smith | 505 Travis St. / Suite 630, | Shreveport, La. 71101 | Office Phone: 318-673-5544 |
12. Your Contact Information
14. First Name*
15. Last Name*
17. Email Address*
19. Person Discriminated Against (IF other than the Name Listed Above)

    Include:   Address: City, State, and Zip Code: Telephone: Home: 

21. Company |Organization Name

    (If None, Leave Blank)

23. Address
25. City*
26. State*
27. Zip Code*
29. Telephone Number*
30. Your Email
32. Grievance Information

    Please provide information below that  may help us address your grievance.

34. Was a City Employee Involved in Discriminating Acts

    1. YES
    2. NO
35. (If Yes) please provide City Employee's Name and Work Location at the time discrimination occurred.
36. Location Where Discrimination Occurred
38. Please list brief details of grievances to help us assist you
42. Does this disability limit or restrict participation?

    Please select Yes/No  | Select the type of limitation closest to the challenge/obstacle you are facing.

    1. Yes
    2. No
43. If yes, what type:
    -- Select One --Facility Accessibility - Entry / ExitFacility Accessibility Exterior/Interior NavigationProgram: Access, Accommodation, ActivitiesServices: Access, Accommodation, ActivitiesSPORTRAN Paratransit - On-DemandSPORTRAN - Fixed LinePUBLIC INFRASTRUCTURE -NAVIGATION

    Select the Option best describing your challenges, preventing participating in  Program, Service, Activity, Facility, Paratransit, Navigating Public Infrastructure

45. Describe the acts of discrimination *

    Additionally:  Provide the name(s) where possible of the individuals who discriminated?

46. Have efforts been made to resolve this complaint through Local City of Shreveport, ADA Coordinator Office*

    1. Yes
    2. No
47. (IF yes, what is the status of the grievances
49. Please state the Remedy and/or Resolve you are seeking? *
51. IF, you were dissatisfied with City of Shreveport Determination and Appeals, Please describe briefly your points of disagreement
53. If the complaining party is not satisfied with the results of the appeal, he or she may file a complaint with the appropriate agency or department of the Federal government. Contact the U.S. Department of Justice for information about how to file a complaint with the agency.
55. U.S. Department of Justice | 950 Pennsylvania Avenue, NW Civil Rights Division Disability Rights Section-1425 NYAV | Washington, D.C. 20530 |Voice: (202) 307-0663 | Toll-Free Voice: (800) 514-0301 | Toll-Free TTY: (800) 514-0383 Fax: (202) 307-1197 | Web Address: http://www.ada.gov
59. Has the complaint been filed with another Bureau of the Department of Justice or any other Federal, State or local governing or civil rights agency or court?*

    1. YES
    2. NO
60. (If Yes) please list the information of Agency or Court

    List : Agency or Court, Contact Person, Address, City, State, and Zip Code,  Telephone Number 

61. Describe any specific accommodations and/or modification you have previously requested for this particular concern/issue?
62. If you filed complaint with another agency list date complaint was filed
    If you filed complaint with another agency list date complaint was filed

    If you filed complaint with another agency list date complaint was filed
64. Do you intend to file a complaint with another Bureau of the Department of Justice or any other Federal, State or local governing or civil rights agency or court?*

    1. YES
    2. NO
65. (If Yes) please list the information of Agency or Court

    List : Agency or Court, Contact Person, Address, City, State, and Zip Code,  Telephone Number 

66. Date you plan to file?
    Date you plan to file?

    Date you plan to file?
70. Additional Comments / Questions
Leave This Blank:


72. 1. Receive an email copy of this form.
73. Email address

    This field is not part of the form submission.

74. Submit Submit and Print

* indicates a required field