ADA Complaint Form

Mailing Address:

ADA Coordinator
#10 Public Square
Belleville, IL 62220




  • Terms and Conditions

    I confirm that:
    1) the information provided about the name of the person completing the form is correct,
    2) The information provided in the “Describe Grievance” section is, to the best of my knowledge, true and
    3) if I completed this form on behalf of the person who was discriminated against, I am authorized to do so.

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