Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

ADA Complaint Form

  1. When did this event occur?

  2. Digital Signature: I understand that the information contained in this form is accurate to the best of my knowledge.*

  3. Best way to reach you concerning the content in this form?*

  4. If you require assistance completing this form or need an alternate format, please contact Attn: Transportation Department, City Hall, 166 Lincolnway, Valparaiso, IN 46383. (219)462-1161

  5. Upon review, a formal written complaint containing the complainant's signature may be required to verify the authenticity of this complaint.

  6. Leave This Blank:

  7. This field is not part of the form submission.