ARC OF INDIAN RIVER COUNTY TRANSPORTATION COMPLAINT FORM
 
What is the nature of the ADA complaint (please include the time/date and location of the incident):


For agency use: 
Action taken by The Arc of Indian River County in response to the ADA complaint:

Has an appeal been requested?
 ☐     Yes
 ☐     No
 Result of appeal (include agency staff responsible for appeal process and date/time/location of meeting)

Has this appeal been resolved?
 ☐     Yes
 ☐     No
 Please describe any further action or follow-up required:
ADA Coordinator Signature                          Date

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