Learning Disabilities - Signature Sheet

{Insert Name of Program}

Americans with Disabilities Act

SIGNATURE SHEET 

By signing below, I acknowledge that I have either read or had explained to me the Notice Under the Americans with Disabilities Act and the Grievance Procedure.

I understand that I may have a copy of the Notice under the Americans with Disabilities Act if I want one.

I understand that if I have questions, concerns or complaints I should contact the {Insert Name of Person coordinating ADA complaints}, at {Insert telephone number}.