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Human Relations Commission Intake Questionnaire - Public Accommodation

  1. If other than Elgin, please enter city.

  2. If other than IL, please enter state.

  3. * Denial of full equal enjoyment of the services of a facility
    * Inaccessible route from entrance to the area where goods or services are provided
    * Lack of handicap parking
    * Inaccessible entrance/restrooms
    * Denied service based on the use of a guide, hearing, or support dog.

  4. If other than Elgin, please enter city.

  5. If other than IL, please enter state.

  6. Leave This Blank:

  7. This field is not part of the form submission.