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ADA Complaint Form

  1. County Seal

  2. COUNTY OF HUMBOLDT DISCRIMINATION ON THE BASIS OF DISABILITY COMPLAINT FORM

    This form should be used by all persons who wish to file a complaint against the County or its officers or employees because of discrimination on the basis of disability. The completed form should be filed with either the County Personnel Director, the County Administrative Officer or the County official directly responsible for the service, program or activity, whomever is most appropriate under the circumstances. Investigation of all complaints shall be handled in an expedited fashion.

  3. Questions regarding the complaint procedure or the County's policy on nondiscrimination on the basis of disability may be directed to Karen Clower at:

  4. Physical Address

    County of Humboldt - ADA 825 5th Street, Room 112 Eureka, CA 95501

  5. Email

    ADA@co.humboldt.ca.us

  6. Phone

    (844) 365-0352

  7. Check if applicable:

  8. 4. Has this complaint been discussed with the responsible county employee or department?

  9. By typing your name and date above and clicking the 'submit' button, you certify that all statements or allegations made herein are true to the best of your knowledge.

  10. Leave This Blank:

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