Village Community Development Districts

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VCDD Grievance Form
This form can be used to file a complaint if you feel that the Village Community Development Districts have not provided accommodation for a disability. All complaints should be filed within 30 days of the alleged violation. Please give as much information and details as possible when filling out the Description of Violation, including locations, persons involved, etc. Please contact the District ADA Coordinator if you have any questions or need assistance in filling out this form.

Field names in bold indicate a required field.		VCDD ADA Grievance Procedure

Reporting Individual

Name	*
Address	*
City	*	State	*	Zip	*
Phone	*
E-Mail Address	*

Person Discriminated Against same as reporting individual

Name
Address
City		State	Zip
Phone

Date Violation Occurred	(mm/dd/yyyy) *
Description of Violation	*
Additional Comments

Thank you for completing this form. Please click on SUBMIT to e-mail your complaint directly to the District’s ADA Coordinator.