BOE-351 (S1) (1-04)
AMERICANS WITH DISABILITIES ACT (ADA)
GRIEVANCE FORM

STATE OF CALIFORNIA
BOARD OF EQUALIZATION

INSTRUCTIONS

This is a printable form. Simply complete, print and send to: California Department of Tax and Fee Administration, Equal Employment Opportunity Office, P.O. Box 942879 Sacramento, CA 94279-0051

GRIEVANT INFORMATION
PERSON ALLEGING ADA VIOLATION (if other than grievant)
BOE SERVICE, PROGRAM OR FACILITY
ALLEGEDLY IN VIOLATION
HAS THIS CASE BEEN FILED WITH THE DEPARTMENT OF JUSTICE OR OTHER GOVERNMENT AGENCY OR COURT?
COMPLETE THE FOLLOWING IF YOU ANSWERED
“YES” TO THE PREVIOUS QUESTION



SIGNATURE

DATE