ADA Information Form

The Process for ADA Assistance

The Governor's Commission was established to serve as a source of information to the public regarding all services to persons with a disability. The GCD does not provide individuals with legal advice. However, if you are in need of assistance regarding the Americans with Disabilities Act (ADA) and the rights protected thereunder, please feel free to contact us at the telephone number, mailing address, or email address below. We encourage you to complete the Information Form to fully describe the writing the events which you would like to discuss. Although we welcome your calls, it may be easier for you to complete this form in advance so that we may address your inquiry in an expeditious and thorough manner. Kindly submit the Information Form to us via email, mail, or online so that our staff may review the details and respond.

Answer all questions as completely as possible. Attach copies of all relevant documents to your Information Form.

For email and mail submissions, click here for a pdf version of the form.

The GCD does not accept any information from anonymous individuals. You must completely fill out the Form with your name and the requested information. Filing a false form may result in a referral to the New Hampshire Attorney General's office of other entity for review and possible legal action.

Email: disability@gcd.nh.gov

Phone: 1-800-852-3405 (Toll free in NH) or (603) 271-2773

Name

Telephone

Best time to call

Confirm Email

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Date the Incident Occurred

Name of the business, individual etc. that may have overlooked the ADA

Have you contacted the business/individual?

Yes

May we contact the business or individual?

Yes

Have you contacted any other agency?

Yes

If so, please provide the agency name and address.

Have you hired a lawyer?

Yes

If so, please provide the lawyer's name and address.

Please provide a brief description of the incident.

Include the issues which you have experienced and what you think is a fair solution. Attach additional documentation if necessary. We may contact you if more information is needed.

Please read before signing below:

In filing this Information Form, I understand that the Governor's Commission on Disability (GCD) is not my private attorney, but is a resource for referrals. I also understand that if I have any questions concerning my legal rights or responsibilities, I should contact a private attorney. I have no objection to the contents of this Form being forwarded to the business or individual who is the subject of my inquiry.

The above information is true and accurate to the best of my knowledge.

Signature

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