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2. The City of Lebanon ensures that no person or groups of persons shall, on the grounds of race, color, sex, religion, national origin, age, or disability, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any and all programs, services, or activities administered, its recipients, sub-recipients, and contractors. To request an accommodation and/or an alternate format, please contact Kathleen Vail, ADA/504 Coordinator at 615-443-3647 ext. 2320
4. Check one

   1. Accommodation
   2. Barrier Removal
6. Name of Complainant*
7. Email Address
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
17. Preferred Method of Contact
    Email, Telephone, Text, ect.
19. Accommodation needed or location of barrier
21. A brief statement of why the accommodation is needed or barrier removed
23. Upload a picture of the barrier to be removed
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field