2. Use this form to file an appeal of an initial decision of an ADA Title II non-compliance complaint. Please use one form per appeal.
6. Date:*
   Date:
8. Please provide your contact information:
10. First Name*
11. Last Name*
13. Address1:*
15. Address2:
17. City:*
18. State:*
19. Zip:*
21. Phone Number (day)*
22. Phone Number (evening):*
23. Email:
25. Preferred Method of Contact:*
27. Please describe the problem you encountered:*
29. Please describe the original accommodation request or original complaint of noncompliance and the bureau response. *
31. Attach or upload a copy of the original complaint.
33. Attach or upload a copy of the bureau response.
35. Date of original request or complaint:*
    Date of original request or complaint:
37. Date of receipt of initial decision/response:*
    Date of receipt of initial decision/response:
39. Please provide, where possible, the names of any individuals at the City of Creve Coeur involved in the request or complaint:
41. Please describe the alleged violation:*
43. Please describe the remedy sought:*
45. To include more information, please attach separate sheet(s) of paper as necessary. Or attach a file (in Microsoft Word or Adobe PDF format) below.
47. Attach file of additional information.
49. Please submit the completed form by clicking on "Submit" below. Form can also be submitted:
51. By Mail
    City Administrator, 300 North New Ballas Road, Creve Coeur, MO 63141
52. By Email
    City Administrator
53. By Fax
    (314) 872-2539
55. For more information about completing and submitting this form or about the Complaint Process, please visit our Accessibility page.
    Accessibility Page
57. The City Administrator will conduct the investigation necessary to determine the validity of the alleged violation and reconsider the initial decision/response. If appropriate, the City Administrator will arrange to meet with the appellant to discuss the matter and attempt to reach an informal resolution of the appeal. The City Administrator will make a final determination within 45 business days from the date of the filing of the request for reconsideration. Any informal resolution of the appeal will be documented in the City's ADA Complaint File.
    
    The resolution of any specific complaint will require consideration and balancing of varying circumstances, such as the specific nature of the disability; the nature of the access to services, programs, or facilities at issue and the essential eligibility requirements for participation; the health and safety of others; and the degree to which an accommodation would constitute a fundamental alteration to the program, service, or facility, or cause an undue hardship to the City. Accordingly, the resolution by the City of any one complaint does not constitute a precedent upon which the City is bound or upon which other complaining parties may rely.
    
    Use of the City's appeal procedure is not a prerequisite to the pursuit of other remedies. If the appellant is dissatisfied or does not wish to file an appeal through the City's ADA Appeal Procedure, the appellant may file a complaint directly with the United States Department of Justice or other appropriate state or federal agency.
    
    If you have any questions please contact Mark Perkins, City Administrator at 314-872-2511.
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59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit Submit and Print

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