Services Information
for People with Disabilities Grievance Form

Name                
Address1          

Address2           

Telephone No. 

E-mail 
            

What kind of comment would you like to send?

Complaint Problem Suggestion

Information regarding alleged discrimination on the basis of disability in the provision of services, activities, programs, or benefits by the Louisiana State Capitol.

Date of incident:                                
Location of incident (office, floor, area): 

Please give a description of your complaint, problem, or suggestion.

 

         

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