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Frederick County, Maryland - ADA - Complaint/Grievance Form

  1. xxx-xxx-xxxx

  2. If a Representative is completing this form, provide the Representative's name and contact information

  3. Please note: All complaints/grievances are public records. Alternative means of filing complaints, such as personal interviews or a tape recording of the complaint will be made available for persons with disabilities upon request.
    Please answer all of the following questions:

  4. Type name

  5. This form will be submitted to the ADA Coordinator:
    Christine Cambareri Kay, Division Director
    Citizens Services Division
    Frederick County Government
    401 Sagner Avenue, Frederick, MD 21701
    301-600-1454 Email: ADA@frederickcountymd.gov

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