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Serving Jackson, Harrison, and George Counties
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ADA Complaint Form

Use this form to report discrimination you experienced in a CASOMS program or service. You may also file on behalf of another person with their permission.

All information you provide will be sent directly to our ADA Coordinator for review. Fields marked with * are required.

Your Information Tell us how to contact you about your complaint.
Are You Filing for Yourself? If you are filing this complaint on behalf of another person, we need their information and your permission to proceed.
Basis of Your Complaint Select the reason(s) you believe you were discriminated against. Check all that apply.

Complaints must be filed within 180 days of the incident.

What Happened Describe the incident in as much detail as you can. Include the names of people involved, where it happened, and any witnesses.
Prior Complaints Let us know if you have already filed this complaint with another agency.
Submit Complaint

What Happens After You Submit

Once we receive your complaint, here is what to expect:

  1. We Acknowledge Your Complaint

    You will receive a written letter confirming that we received your complaint and whether our office will investigate.

  2. We Investigate

    An investigator will review the facts of your complaint. This takes up to 90 days. If we need more information from you, we will contact you in writing. You will have 10 business days to respond.

  3. You Receive Our Decision

    You will receive either a closure letter (no violation found) or a letter of finding (violation found with corrective actions). If you disagree, you have 7 days to appeal.

Questions About Your Complaint?

Vanessa Gibson, Executive Director and ADA Coordinator

Phone: (228) 769-3292

Email: vgibson@casoms.org

5343 Jefferson Ave. / P.O. Box 8723, Moss Point, MS 39562

Monday through Friday, 8:00 AM to 4:30 PM

View the full complaint procedure

Need Help Filing?

If you need assistance completing this form or would prefer to file by phone, mail, or in person, we are here to help.

Contact Our Office Request an Alternative Format
(228) 769-3292