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2. Complaints and Grievances

   Calvert County Government is committed to ensuring equal access to services, programs and activities for all residents, in compliance with the Americans with Disabilities Act (ADA). The form below allows individuals to submit a complaint or grievance if they believe they have been denied access or discriminated against by a County department, facility or service due to a disability. Calvert County has an established grievance procedure for ADA complaints, comments and concerns. View the procedure.

   Please note: This form is intended for concerns related to Calvert County Government services only. If your complaint involves a private business or non-governmental entity, you should contact the U.S. Department of Justice at www.ada.gov or call the ADA Information Line at 1-800-514-0301 (Voice) or 1-800-514-0383 (TTY).

4. First name
5. Last name
7. Email address
8. Phone number
10. Address
12. City
13. State
14. Zip
16. Please note: All complaints/grievances are public record. Alternative means of filing complaints will be made available for persons with disabilities upon request. Please answer all of the following questions:
18. Describe in detail the event or problem for which you are seeking ADA relief. If known, provide the names of all individuals who were involved and when and where the event occurred.
20. If this is a general request for an accommodation, describe the functional limitations caused by your disability for which you are requesting this accommodation.
22. Describe any accommodations that you believe would minimize or eliminate the barriers to your participation in the County's services and programs:
24. Electronic signature
25. Date
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit Submit and Print

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