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Accessibility Complaint (Grievance) Form

Complaint of Access Violation or Discrimination on the Basis of Disability
The City of Bremerton will make every reasonable effort to ensure that confidentiality is maintained throughout the complaint, investigation, and corrective action process to the extent consistent with the law. This means that the City will share any sensitive information you provide here only on a need-to-know basis.
Individual identifying access violation or discrimination
First Name*
Last Name*
Address*
City*
State*
Zip*
Telephone*
Authorized representative of individual above (if any)
First Name
Last Name
Address
City
State
Zip
Telephone
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