Title II Complaint Form

Alexandria International Airport

Purpose: In accordance with Title II of the Americans with Disabilities Act (ADA) of 1990, Alexandria International Airport makes all programs and services associated with its operation accessible to all persons with disabilities. Please, use this form to file a grievance if you believe that you were denied access to an Airport program or service based on disability.

Instructions: Submit this webform electronically below, or mail it to:

Alexandria International Airport
Attn: David Keller, ADA Coordinator
1611 Arnold Drive
Alexandria, LA 71303

Complainant Information

Complainant Name(Required)

First Last

Email Address(Required)

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Home Phone

Business Phone

Person (Other than Complainant) Alleging Violation

Name(Required)

First Last

Email Address(Required)

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Home Phone

Business Phone

Airport Service, Program, Opportunity, or Activity Allegedly in Violation

Date Alleged Violation Occurred

Location

Description of Service, Program, Opportunity, or Benefit or Encounter

Name or Description of Alleged Violator (Airport, Tenant, Concessionaire, Contractor, Other)

Description of Alleged Violation and Requested Remedy

Filed with Department of Justice or other government agency/court?

Yes

If Yes, Provide Agency or Court Information

Agency or Court

Contact Person

Agency/Court Address

Street Address City State / Province / Region ZIP / Postal Code Country

Agency/Court Phone

Date Filed

Other Comments

Additional Information

Signature (Typed Name)(Required)

First Last

Date

A copy of this complaint will be forwarded to:
Federal Aviation Administration
Office of Civil Rights, ACR-1
800 Independence Avenue, S.W.
Washington, D.C. 20591

Alexandria International Airport