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LANGUAGE ACCESS COMPLAINT CITY OF BLACKFOOT Name (Printed) Date Street Address City State Zip Code ( ) Cell ( ) Home ( ) Work Phone Email Address Submitted on behalf of: Self ____Another person (First & Last Name) Your comments on this Language Access Complaint will help us to improve the City of Blackfoot’s language access services for limited English proficient (LEP) persons. We will contact you within 30 days. My first language is: My complaint is regarding: Forms Meetings Services Other Please provide details of your complaint below. Feel free to add an extra page if needed: Gregory Austin Human Resources Director ADA Coordinator / Fair Housing Officer Submit your complaint via email to: [EMAIL REDACTED] OR Via Fax to: [PHONE REDACTED] OR bring to City Hall at 157 N Broadway, Blackfoot, ID 83221