Grievance Form Page

Grievance Form

If you need assistance completing this form or require an alternative format or reasonable accommodation because of a disability, please contact MVTA Customer Service at 952-882-7500 or mvta@mvta.com

Grievance Form

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This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Email(Required)

Phone(Required)

Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Person claiming an accessibility issue (if different from above):(Required)

Location of incident(Required)

Bus number, route, stop, facility, or park-and-ride where the issue occurred.

Date of incident(Required)

Names of MVTA employees involved (if known)

Supporting documents upload

Max. file size: 256 MB.

Preferred accommodation for communication

Large print, Braille, email, phone, relay service, etc.

Have you filed this grievance with another agency?(Required)

Yes

If yes, please list with who:

Description of issue:(Required)

Remedy you’re seeking:(Required)

Electronic signature / certification(Required)

Please print your name to certify the information provided is true and accurate to the best of my knowledge.

Date signed(Required)