Please tell us if you need assistance completing this form because you do not speak English or have a disability. Free language assistance and/or other aids and services
are available upon request. Please contact the Town of Mooresville's ADA-504 Coordinator, Christopher Russell, Risk & Safety Manager at 704-662- 524 or by email at crussell@mooresvillenc.gov 

ADA Complaint Form (PDF)

Disclaimer: Information submitted on this form will be sent via email. To protect sensitive information, do not request the following information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, and passwords.

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Name (Complainant)

Phone Number

Home Address

If applicable, the name(s) of the person(s) who you believe treated you unfairly or improperly:

Date of the Incident:

Primary type of disability: Mobility ognitive/Intellectual/Developmental Learning Mental/Psychiatric Vision Hearing Seizure Speech Other

Email Address

Briefly explain what happened and how you feel you were treated unfairly or improperly. Please include how you feel that others were treated differently than you.

Is there any other information that you feel may be relevant to this incident?