Vatican Library
Redefining the role of government as it
affects the lives of people with disabilities
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P.O. Box 77
Boston MA 02133
617 499-6957

July 05, 2008
ADA Complaint Form
for
Massachusetts Residents
                                 
                                                       

                                                                                    

                                                

Use this form to notify us of a matter of noncompliance with the Americans with Disabilities Act.
 
Please read all of these instructions first:

This form was designed to be accessible. See "Special instructions for Jaws Users below."

Data field labels marked with "ML" are done so to notify screen readers that the textbox for data entry contains multiple lines.

Data field labels marked with * are required.

If you are logged on, your account contact details will be filled-in automatically.  You may edit these fields for this form, but changes will not be saved to your account.

An error message will appear next to the fields of any required information not supplied. 

If you require assistance with the completion of this form you may contact us.

If you have a photo of the violation you may send it to us via email as an attachment.  Please put "ADA Complaint" in the email subject line and send it to this email address.

Screen Readers Only... the last two items on this page are not accessible in Forms Mode or MSAA mode. When you reach the last field on the form switch out of Forms mode and arrow down to the next two controls.  These two controls are described next.

To receive a copy of this form via email select the "Also send me a copy" checkbox near the bottom of the form. 

Select the "Submit" link at bottom to complete your complaint submission.   A confirmation page will appear if all required information is supplied.

Special instructions for Jaws Users, 7.0 or earlier. Click Here.
 
Today's Date (like 1/1/2007)*
Your Full Name*
Street Address (ML)*
City or Town*
State*
Zip Code*
Telephone or TTY*
Email Address*
Type of Violation:
Name of Place were alleged violation exists or occured (ML)*
Location of Alleged Violation (ML)*
Please describe the ADA violation (ML)*
If applicable, date of alleged violation
If applicable, time of violation (like 23:00 for 11 PM)
Have efforts been made to resolve this complaint through any other means? *
If Yes, what is the status of the complaint? (ML)
Has the complaint been filed with any Federal, state, or local civil rights agency or court?*
If yes, please provide contact details including: Agency, Person, Address, Phone, Date Filed (ML)
Screen Readers Only -- If you have completed your data entry for all items above, please leave forms mode or MSAA mode now and arrow down to the final two controls.
Submit
*Required