Your Name: ______________________________________________________
Your Address: _____________________________________________________
Telephone Number: _____________________ Email: _____________________
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Name of Place With One-Step Problem: _______________________________
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Type of Establishment: _____________________________________________
Address (Include Cross Streets and Zip Code): __________________________
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Telephone Number (include Area Code): _______________________________
Comments: ______________________________________________________
________________________________________________________________
________________________________________________________________
Mail a copy of this form to:
Irma Shore, Park West Finance Station, PO Box 20608, NY, NY 10025. If you have any questions: irma@disabledinaction.org or 212-663-6011.
For additional complaints concerning access issues in public accommodations or housing, please call or email The Commission on Human Rights: 212-306-7330 or tfinkelstein@cchr.nyc.gov or 212-306-7450 or TTY: 212-306-7589 or 212-306-7686.
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