ADA Complaint Form

VTA is committed to ensuring that no person is denied access to its services, programs, or activities on the basis of their disabilities, as provided by title II of the Americans with Disabilities Act of 1990 (“ADA”). ADA complaints must be filed within 180 days from the date of the alleged incident. The following information is necessary to assist us in processing your complaint. If you require any assistance in completing this form, or if you would like to make a verbal complaint, please contact the ADA Coordinator by calling (408) 321-2300

First Name

Last Name

Phone:

Alt: Phone

Email:

Address

City/Town

State/Province

ZIP/Postal Code

Person Preparing Complaint (if different from Complainant):

Preparer Name & Contact Information

Date of Incident:

Please describe the alleged discriminatory incident, including the location(s), if applicable. Provide the names and titles of VTA employees involved, if available.

Limited to 3,000 characters

Upload supporting document as needed: (optional)

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256 MB limit.
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ADA Complaint Form

Check box if you have filed a complaint with any other federal, state, or local agencies.

Agency Name & Contact Information

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