The American's with Disabilities Act (ADA) prohibits discrimination on the basis of disability in State and local government, public accommodations, commercial facilities, transportation, and telecommunications. THIS FORM
may be used to file a complaint with the City of Connersville for alleged violations of ADA. If you need assistance completing this form, please contact us by phone at (765) 825-2158 or TTY by dialing 711. You are not required to use this form. You may write a letter with the same information, sign it and return to the address printed above. All items in bold must be completed for your complaint to be investigated. Failure to provide complete information may impair the investigation of your complaint.