Grievance Form

You may fill out this form to file a complaint with the Disability Law Center. Instead of filling out this form, you may make your complaint in a letter, or you may explain your complaint in person, or over the phone. We will be glade to provide any help you need in making your complaint. Your complaint must be returned to us at 3330 Arctic Boulevard, Suite 103 Anchorage, AK 99503 within 30 working days following the decision of this agency with which you disagree. Please send it to the attention of the Executive Director.

Please complete all sections which apply to your concerns and sign and date below. Also, give you address and phone number. Attach other information that you would like us to consider.

Please Describe the type of help that you requested from the Disability Law Center:

I was told that the Disability Law Center would not provide my services. (Please
indicate date on which you were informed of this decision.) I disagree with this
decision because:

I am unhappy with the services that I am receiving because:

I disagree with the decision of the Disability Law Center to limit services to me or
to close my case (please indicate date on which you were informed of this decision).
I disagree because:

I believe that the Disability Law Center has treated me unfairly or has not carried
out its legal obligations, because:

Attach Additional Explanation or Information as Necessary.

Telephone	Address
Phone: 907-565-1002 Phone/TTY Fax: 907-565-1000 Toll Free: 1-800-478-1234 Phone/TTY (In State Only)	Disability Law Center of Alaska Mail: 3330 Arctic Boulevard, Suite 103 Anchorage, AK 99503 E-mail: akpa@dlcak.org

[Home] [About Us] [Calendar of Events] [Our Services] [News] [Information] [Employment] [Contact Us] [Search]

Grievance Form

Grievance Form

Telephone

Address