Grievance Form

ALABAMA DISABILITIES ADVOCACY PROGRAM
GRIEVANCE FORM

Please compete the sections below which apply to your concerns.

Describe the type of help you requested from ADAP.

Comment *

ADAP told me it would not provide me services. I disagree with ADAP’s decision.
(Explain and indicate the date on which you were informed of ADAP’s decision.)

Comment *

ADAP closed my case or limited the services I would receive. I disagree with ADAP’s decision.
(Explain and indicate the date on which you were informed of ADAP’s decision.)

Comment *

I am unhappy with the services that ADAP provided me.
(Explain and indicate the date on which you were informed of the action(s).)

Comment *

I believe ADAP has treated me unfairly or has not carried out its legal obligations.
(Explain and indicate the date on which you were informed of the action(s).)

Comment *

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Submit

ALABAMA DISABILITIES ADVOCACY PROGRAMGRIEVANCE FORM

ALABAMA DISABILITIES ADVOCACY PROGRAM
GRIEVANCE FORM