Appeal Procedure Please complete this form: Before submitting this Appeal, please make 1. If you are dissatisfied with a written sure you have read East Chicago Transit decision made by East Chicago Transit Accommodation / Complaint Appeals and request to appeal a denial of service Process, the Initial Complaint Process and for Complementary Paratransit, the Appeal Procedure. If you have any Reasonable Accommodation, questions or need assistance in filling out the Termination or Suspension of Service. appeal form, please contact East Chicago Transit. APPEAL FORM or: Contact Information HOURS OF OPERATION 2. If you are dissatisfied with a written Monday - Friday 5:55AM to 8:40PM Saturday decision of a complaint and wish to appeal Please mail, email, fax or deliver this form – 9:05AM to 4:40PM to an initial complaint alleging that to: East Chicago Transit programs, services, Administrative Hours activities, facility or any action is in East Chicago Transit, Monday - Friday violation of Title II of the 8:00AM to 5:00PM Americans with Disabilities Act (ADA). Att. Transit Director: Office Closed on Saturday, Sunday and Holidays (answering machine is available) 5400 Cline Avenue For additional information please visit our East Chicago Indiana 46312 website: http://www.eastchicago.com/department/bustransit Phone: 219-391-8465, Fax; 219-391-8473 or questions on filling out this form call our office 219-391-8465 Indiana Relay 711 or 1-800-743-3333 Indiana Relay 711 or 1-800-743-3333 Website ALTERNATE FORMAT AVAILABLE UPON REQUEST. http://www.eastchicago.com/departments/bus_transit/ __________________________________ State Complaint: ________________________ ** If you have any questions or need assistance in filling out the appeal form, __________________________________ please contact East Chicago Transit. __________________________________ Signature: _________________________________ __________________________________ Date: ____________________________ APPEAL __________________________________ Date: ______________ __________________________________ Name: ____________________________ __________________________________ Thank you for completing this form. Your __________________________________ request will be addressed within 10 business Street Address: ____________________ days after receiving this appeal. Should you __________________________________ be unsatisfied with the response to your City: ______________________ request you may also appeal to: __________________________________ Human Rights Commission / Mayor’s State: ______ Zip Code: ___________ __________________________________ Committee for Disability 1005 E. Chicago Ave. Phone (day): _______________________ __________________________________ East Chicago In. 46312 __________________________________ Tel. 219-391-8477 (evening):__________________________ Fax 219-3918544 __________________________________ Email: ___________________________________ __________________________________ If the decision is acceptable by the Preferred Method of Contact: __________________________________ complainant, the matter is concluded. ___________________________________ __________________________________ Please specify all involved in your request __________________________________ The Americans with Disabilities Act (ADA) for reasonable accommodation or initial does not require East Chicago Transit to complaint of noncompliance: __________________________________ take any action that would fundamentally alter the nature of its programs or services, ___________________________________ __________________________________ or impose an undue financial or ___________________________________ administrative burden. ___________________________________ __________________________________ ___________________________________ ___________________________________ __________________________________ ___________________________________ ___________________________________ __________________________________ ___________________________________ ___________________________________ __________________________________ ___________________________________ Please complete this form: . .