ADA Complaint Form

2. Please complete this form to file a written complaint with the Port of Bellingham or alternatively you may send an email to ADA@portofbellingham.com. Written complaints should be filed with the ADA Coordinator as soon as possible, but no later than 180 calendar days after the alleged violation. If you are unable to file a written complaint due to a disability alternative arrangements can be made by calling (360) 676-2500.

   This grievance procedure may be used by anyone who wishes to file a complaint alleging discrimination on the basis of disability while attending or using the Port’s programs, services or activities. The written complaint should contain information about the alleged discrimination, such as name, address, phone number of complainant and location, date and detailed description of the problem.

   The Port of Bellingham’s ADA Coordinator and/ or designee will contact the complainant within 15 calendar days after receiving the written complaint to discuss the complaint and possible resolutions.

   Only those fields with an asterisk (*) are required. All other fields are optional.

4. Name of person filing complaint:*
6. Person the complaint is being filed for:*
8. Email:*
10. Phone:*
12. Preferred method of contact:

    1. Email
    2. Phone
14. Address1
16. Address2
18. City
19. State
20. Zip
22. Description of Complaint
24. Program/​Service/​Activity/​Facility alleged to be inaccessible:*
26. Date*
    Date
28. Describe the alleged incident/ discrimination or way in which a program / service / activity was not accessible:*

    Where possible, please provide name(s) of individuals involved in the alleged discrimination. 

30. What efforts have been made to resolve this complaint?
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

* indicates a required field