ࡱ>  @ CT[bjbj e D)lllllll3338x}yLG,3B7X7X7X738x8L8(>E.G.G.G.G.G.G$!IRsKRG]l;3838;;RGllX7X7Gd>d>d>;lX7lX7>Ed>;>Ed>d>lld>X7z @\3;d>"?G0Gd>9L;9Ld>llll9Llr>9Zy9@d>949999RGRG$!dN>$!COMPLAINT UNDER AMERICANS WITH DISABILITIES ACT (TITLE II)Michigan Department of Human ServicesInstructions: Please fill out this form completely, in black ink or type. Sign and return to the address on page 2.Complainant Name: FORMTEXT        FORMTEXT      Address: FORMTEXT      CityStateZip Code FORMTEXT       FORMTEXT    FORMTEXT      Telephone: Home:( FORMTEXT    )  FORMTEXT       Business:( FORMTEXT    )  FORMTEXT      Person Completing This Form:(if other than the complainant) FORMTEXT      Address: FORMTEXT      CityStateZip Code FORMTEXT       FORMTEXT    FORMTEXT      Telephone: Home:( FORMTEXT    )  FORMTEXT       Business:( FORMTEXT    )  FORMTEXT      County/Program that you believe has discriminated against you:Name: FORMTEXT        FORMTEXT      Address: FORMTEXT      County: FORMTEXT      CityStateZip Code FORMTEXT       FORMTEXT    FORMTEXT      Telephone Number:( FORMTEXT    )  FORMTEXT      When did the event occur? Date: FORMTEXT      Describe the event providing the name(s) where possible for the individuals who were involved (use space on page 2 if necessary): FORMTEXT       Has the complaint been filed with the Michigan Department of Civil Rights or the Federal Department of Justice or any other federal agency or court?Yes FORMCHECKBOX No FORMCHECKBOX If y^tx      & ( . 0 D F Z \ ^ h j l n ټձټ٭Ջټ~vnjh?cUh?cOJQJhdHCJ KH \^JaJ jh3tUh"-$h}K5CJ KH OJQJ\^JaJ h}KjLh3tUjh7UmHnHujhcUh3tjh3tUh#h,Kh?c hMhMhMhhdH)vxsj $Ifgd(,<kd^$$Ifl4*(4 la.f4 $IfgdM<kd$$Ifl4P*(4 la.f4 $IfgdMZR[B ued$$Ifgd}K<kd$$Ifl4P*(4 la.f4d$$Ifgd?c<kd$$Ifl4P*(4 la.f4 * , . 0 |l/<kd,$$Ifl4*(4 la.f4d$$Ifgd}K<kd$$Ifl4*(4 la.f4 $IfgddH<kdr$$Ifl4*(4 la.f40 B D l n x l\\\d$$Ifgdc<kdl$$Ifl4*(4 la.f4 $Ifgdg)<kd$$Ifl4*(4 la.f4d$$Ifgd}K 0bkd$$Ifl4F<6$*zT    4 la.f4 $Ifgdcbkd$$Ifl4F<6$*zT    4 la.f4   0 2 4 H J L R T X Z n p r | ~ ڳޣޣޣjhdHUjhdHUjJhdHUjhdHUhdHh!h?cCJ KH OJQJ\^JaJ jHh?cUjh?cUh?cjh7UmHnHujh?cUjjh?cU. . 0 kO MBPd$$If]P^gddHbkd($$Ifl4F$ 2 *bX     4 la.f4 $IfgddHd$$Ifgd}K Bd$$If^gddH & * , n p     $ & ( * > @ B F H J L ` b d n p r ڿ޿ڿ޿֝޿ֿ޿ֿ|޿jJhcUjhcUjlhcUhdHOJQJj h3tUj hcUh3tjh3tUh5CJ KH \^JaJ hdHhjh7UmHnHujhdHUjZ hdHU0 * O=d$$If^gdg)<kd $$Ifl4*(4 la.f4d$$Ifgd}Kbkd $$Ifl4F$ 2 *bX     4 la.f4* , l n ucd$$If^gd3t<kdT $$Ifl4*(4 la.f4d$$Ifgd}K<kd $$Ifl4*(4 la.f4 ul/<kdn $$Ifl4*(4 la.f4 $IfgddH<kd $$Ifl4*(4 la.f4d$$Ifgd}K<kd. $$Ifl4*(4 la.f4 ( J r $IfgddHbkd $$Ifl4F<6$*zT    4 la.f4d$$Ifgdr t tk $Ifgdcd$$Ifgdc Bd$$If^gdcbkd$$Ifl4F<6$*zT    4 la.f4r t $&*,@BDNPT   "ꤕzɉojh3tUj\h3tUh3tjh3tUhh?c5CJ KH \^JaJ h?cj\hdHUjhdHUjhdHUjh7UmHnHujLhdHUjhdHUhdH!hdHCJ KH OJQJ\^JaJ + Rpg $Ifgdcd$$Ifgdc MBPd$$If]P^gdcbkd*$$Ifl4F$ 2 *bX     4 la.f4RTO?d$$Ifgd}K<kd$$Ifl4P*(4 la.f4d$$Ifgd?cbkd$$Ifl4F$ 2 *bX     4 la.f42468|l/<kd$$Ifl4*(4 la.f4d$$Ifgd}K<kdD$$Ifl4*(4 la.f4 $Ifgd3t<kd$$Ifl4*(4 la.f4"$.0LNbdfpr"$&(<>@JLNPxzjph3tU!h3tCJ KH OJQJ\^JaJ jh3tUjh3tUj4hcUh3tOJQJjh3tUj|h3tUh3thjh7UmHnHujh3tU48JLtvl<kd$$Ifl4*(4 la.f4 $Ifgd3t<kd$$Ifl4*(4 la.f4d$$Ifgd|llld$$Ifgdc<kd6$$Ifl4*(4 la.f4 $Ifgd3t<kd\$$Ifl4*(4 la.f4&NP0bkdr$$Ifl4F<6$*zT    4 la.f4 $Ifgdcbkd$$Ifl4F<6$*zT    4 la.f4Ptvl<kdN$$Ifl4*(4 la.f4 $Ifgdc<kd $$Ifl4*(4 la.f4d$$Ifgdc   "$.048:<PRT^`bdhPP˸ް˸~somoUhj| h7Uj h7Ujh?cUhB^3hh:h"-jbh7Uh7jh7Uh?c5CJ KH \^JaJ h,Kh?cj hcUh3tjh7UmHnHujh3tUjh3tU) 248:|l/<kd$$Ifl40*(4 la.f4d$$Ifgdc<kd$$Ifl4*(4 la.f4 $Ifgdc<kd$$Ifl4*(4 la.f4:bdha<kd<$$Ifl4*(4 la.f4d$$Ifgd}K<kd$$Ifl4*(4 la.f4d$($If^gd,K$d$$Ifa$gdB^3 $Ifgd?cd$$Ifgd}K<kd$$Ifl4p*(4 la.f4cSd$$Ifgd}Kkd $$Ifl4ֈ8~ *vh*vl4 la.f4BPDPlPnPul/<kd#$$Ifl4*(4 la.f4 $Ifgdc<kdD"$$Ifl4*(4 la.f4d$$Ifgd}K<kd!$$Ifl4p*(4 la.f4es give name of agency or court: FORMTEXT      Contact Person: FORMTEXT      Address: FORMTEXT      CityStateZip Code FORMTEXT       FORMTEXT    FORMTEXT      Telephone Number:( FORMTEXT    )  FORMTEXT      Date Filed: FORMTEXT      Do you intend to file with another agency or court?Yes FORMCHECKBOX No FORMCHECKBOX Agency or Court: FORMTEXT      Address: FORMTEXT      CityStateZip Code FORMTEXT       FORMTEXT    FORMTEXT      Telephone Number:( FORMTEXT    )  FORMTEXT      Additional space for answers: FORMTEXT      Signature:DateReturn to:Mary Hall-Thiam Office of Equal Opportunity and Diversity Programs PO Box 30037 Lansing, MI 48909 Phone: (517) 373-8520 Fax: (517) 335-6453Authority: Sec.709(c), Title VII, Civil Rights Act of 1969, as amended. Response: Voluntary Penalty: NoneDepartment of Human Services (DHS) will not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area. DHS-866 (Rev. 5-09) Previous edition obsolete. 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MYINFO.ini B@F:UserInfo Boss Name ,!| MYINFO.ini B@FUserInfo Boss Title ,!~ MYINFO.ini B@FGet user info from INI fileUserInfoName MYINFO.ini %Z' \UserInfoTitle MYINFO.ini %Z' ^UserInfoAreaCode MYINFO.ini %Z' (UserInfoPhone MYINFO.ini %Z' `UserInfoYourExt MYINFO.ini %Z' bUserInfoFaxAC MYINFO.ini %Z' dUserInfoFax MYINFO.ini %Z' fUserInfoOffice MYINFO.ini %Z' hUserInfoAddress MYINFO.ini %Z' jUserInfoCity MYINFO.ini %Z' lUserInfoState MYINFO.ini %Z' nUserInfoZip MYINFO.ini %Z' pUserInfoCO MYINFO.ini %Z' rUserInfoDI MYINFO.ini %Z' tUserInfoSEC MYINFO.ini %Z' vUserInfoUN MYINFO.ini %Z' xUserInfoWKR MYINFO.ini %Z' zUserInfo Boss Name MYINFO.ini %Z' |UserInfo Boss Title MYINFO.ini %Z' ~ Update Form with user info WorkerName %\F workerName \ B@^g WorkerTitle %\F WorkerTitle ^ B@^gWorkerAreaCode %\FWorkerAreaCode ( B@^g WorkerPhone %\F WorkerPhone ` B@^gWorkerExtension %\FWorkerExtension b B@^gFaxAC %\FFaxAC d B@^g WorkerFax %\F WorkerFax f B@^g Countynumber %\F Countynumber r B@^gDistrict %\FDIstrict t B@^gSection %\FSECtion v B@^gUnit %\FUNit x B@^gWorker %\FWorker z B@^g CountyName %\F CountyName h B@^g CoAddress %\F CoAddress j B@^gCoCity %\FCoCity l B@^gCoState %\FCoState n B@^gCoZip %\FCoZip p B@^gSupervisorName %\FSupervisorName | B@^gSupervisorTitle %\FSupervisorTitle ~ B@^g. 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