Form Center

By signing in or creating an account, some fields will auto-populate with your information.

ADA Discrimination Complaint Form

  1. Atttachments*
  2. The complaint will not be accepted if it has not been signed. Please sign and date this complaint form below. You may attach any written materials or other supporting information tha you believe is relevant to the complaint.
  3. Submit completed form to:
    Bev Bartlett
    Human Resource Officer
    234 Main St. PO Box 390 Chadron, NE 69337
  4. Leave This Blank:

  5. This field is not part of the form submission.