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Americans with Disabilities Act Complaint Form

  1. Have you filed a complaint with any other federal, state, or local agencies?*
  2. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  3. Signature PA 2021
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  5. This field is not part of the form submission.