HOURS OF OPERATION Appeal Procedure Please complete this form Before submitting this

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HOURS OF OPERATION Appeal Procedure Please complete this form Before submitting this Powered By Docstoc
					                                             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:




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