Minnesota Judicial Branch - Grievance Form

Full Name of Grievant *

Street Address 1 *

Street Address 2

City *

State * Two letter standard state abbreviation

ZIP code *

Phone Number *

Email *

Retype Email *

Date Date the alleged discriminatory act or decision occurred

Court program or service involved Name of the court program or service involved that is the subject of this grievance

Type of accommodation requested

Description * Describe the alleged discriminatory act or decision (please be specific)

I certify that the above information is accurate *

Grievance Form - ADA Accomodations