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GORDON COUNTY GOVERNMENT ADA GRIEVANCE FORM Name: Address: Phone Number: Email Address: Location of problem: Date noticed: Description of problem: Signature & Date *Please attach additional pages if needed The complaint should be submitted by the grievant and/or his/her designee as soon as possible but no later than 30 calendar days after the alleged violation to: Gordon County Board of Commissioners Human Resources Department ATTN: ADA Coordinator David Gibson 201 North Wall Street, Calhoun Georgia 30701