SOP_NUMBER: 103.63-att-3
TITLE: ADA Accommodation Request Appeal Form
DIVISION: Executive
TOPIC_AREA: 103 Policy-Investigations/Compliance
EFFECTIVE_DATE: 2018-04-20
WORD_COUNT: 278
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/341075
URL: https://gps.press/sop-data/103.63-att-3/

SUMMARY:
This form allows offenders in Georgia Department of Corrections facilities to appeal a Warden's or Superintendent's response to their ADA (Americans with Disabilities Act) accommodation request. Offenders must submit the completed form with supporting documents to the Commissioner's Designee within seven days of receiving the initial response, clearly stating the basis for their appeal. The form includes sections for offender information, appeal reasoning, and receipt acknowledgment at the Commissioner's Designee level.

KEY_TOPICS: ADA accommodation appeal, disability accommodations, ADA request denial, appeal process, offender rights, Americans with Disabilities Act, Commissioner's Designee, facility accommodations, disability services, appeal form

ATTACHMENTS:
  1. Offender ADA Accommodation Request Form
     URL: https://gps.press/sop-data/103.63-att-1/
  2. Warden's_Superintendent's ADA Accommodation Request Response
     URL: https://gps.press/sop-data/103.63-att-2/
  3. ADA Accommodation Request Appeal Form
     URL: https://gps.press/sop-data/103.63-att-3/

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FULL TEXT:
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SOP 103.63
Attachment 3

4/20/18
**DATE APPEAL RECEIVED FROM OFFENDER_________________________________________**


ADA ACCOMMODATION REQUEST APPEAL FORM

______________________ _____________ _________________________________
OFFENDER NAME I.D. NUMBER         ADA ACCOMMODATION NUMBER

I reject the Warden’s/Superintendent’s response to my ADA Accommodation Request. The basis for this
appeal is as follows:
______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

NOTE: The option to appeal a proposed resolution rests with the offender. All ADA request denials indicating a desire for appeal
will be forwarded to the next level. However, to allow a full review of all issues the offender wishes considered, he or she should
state these reasons clearly in the appeal. Statements such as "not satisfied" or "appeal further" will result only in a general review.
This appeal form, along with supporting documents, must be submitted to the Commissioner’s Designee at P.O. Box 1529, Forsyth,
Georgia 31029 within seven (7) days of receipt of the Warden’s/Superintendent’s response.

# OFFENDER’S SIGNATURE: ______________________________________DATE:

(Reproduced locally)
# --------------------------------------------------------------------------------------------------------------

**RECEIPT FOR ADA ACCOMMODATION REQUEST APPEAL FORM**

**AT THE COMMISSIONER’S DESIGNEE LEVEL**

OFFENDER’S NAME: I.D.#

I ACKNOWLEDGE RECEIPT OF ADA REQUEST APPEAL NUMBER FROM THE ABOVE
OFFENDER.

DATE: / / COMMISSIONER’S DESIGNEE’S SIGNATURE:


Retention Schedule: Upon completion, the original of this attachment shall be placed in the offender’s institutional file and retained according to
the official retention schedule for this file. A copy of this attachment shall be placed in the medical file and mental health file, as necessary, and
retained according to the official retention schedule for that file. A copy of this attachment shall also be maintained in the Facility ADA
Coordinator’s, Agency’s ADA Coordinator’s, and Commissioner’s Designee’s offices for four (4) years following the final decision of the request.