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Disability Complaint Form
Your complaint form has been submitted.
Disability Complaint Form
* Last Name
* First Name
M.I.
* Address
* City
* State
* Zip Code
* Email
* Phone Number
* This form is being filled out by
-- Select one --
Self
Someone on behalf of the voter
HC Election Judge, Election Worker, or Staff
* Election
May 01, 2021 - Joint Election
March 28, 2021 - Joint Election
* Poll Location
-- Select one --
BakerRipley Cleveland Campus
Humble Civic Center
Kingwood Community Center
Lee College Sports Arena/Wellness Center
MultiCultural Center
Prairie View A&M University Northwest
San Jacinto Community Center
SRD001C - Harris County Attorney Conference Center
SRD126P - Prairie View A&M University Northwest
SRD127H - Lake Houston Church of Christ
SRD127Y - Kingwood Community Center
SRD128D - JD Walker Community Center
SRD128J - San Jacinto Community Center
SRD128P - East Harris County Activity Center
SRD128Z - Crosby Community Center
SRD129E - El Franco Lee Community Center
SRD129M - MultiCultural Center
SRD129U - University of Houston Clear Lake
SRD129W - Webster Civic Center
SRD130S - Saint John Lutheran Church and School
SRD131K - Windsor Village Community Center
SRD132Z - Hampton Inn and Suites Houston Katy
SRD134V - West University Place City Hall
SRD138K - Katherine Tyra Branch Library
SRD141U - Humble Civic Center
SRD144 - Lee College Sports Arena/Wellness Center
SRD144Z - John Phelps Courthouse
SRD145H - City of South Houston Municipal Court
SRD145R - BakerRipley Cleveland Campus
SRD150B - Big Stone Lodge
A Community of the Servant Savior Presbyterian Church
Atascocita Middle School
Bailey Elementary School
BakerRipley Cleveland Campus
Beverly Hills Community Center
Big Stone Lodge
Bobby Shaw Middle School
Calvary Hills Funeral Home
Carroll Teague Elementary School
Cedar Bayou Junior School
City of Nassau Bay Council Chamber
City of South Houston Municipal Court
Crosby Community Center
De Zavala Elementary School
Deepwater Junior High School
Deerwood Elementary School
Deussen Park Senior Center
Eagle Spring Elementary School
East Harris County Activity Center
El Franco Lee Community Center
Emmott Elementary School
Fairmont Elementary School
Fall Creek Elementary School
Fallbrook Church
Foster Elementary School
Frazier Elementary School PISD
G W Robinson Elementary School
Garfield Elementary School
Genoa Staff Development Center
George H Gentry Junior High School
Golden Acres Elementary School
Goose Creek CISD Administration Building
Goose Creek Memorial High School
Greater Saint Matthew Baptist Church Southwest Campus
Hampton Inn and Suites Houston Katy
Harris County Attorney Conference Center
Harris County WCID 70
HC Public Library Kingwood Branch
Hidden Hollow Elementary School
Humble Civic Center
Humble ISD Collaboration Center
Humble Middle School
JD Walker Community Center
John Phelps Courthouse
Katherine Tyra Branch Library
Keller Middle School
Kingwood Community Center
Kingwood High School
Kingwood Middle School
Kingwood Park High School Performing Arts Center
Lake Houston Church of Christ
Lake Houston Church of the Nazarene
Lakeshore Elementary School
Laura Welch Bush Elementary School
Lee College Sports Arena/Wellness Center
Lone Star Flight Museum
McMasters Elementary School
Memorial Parkway Junior High School
Mildred Jenkins Elementary School
MultiCultural Center
Navarre Funeral Home Inc.
Nelda Sullivan Middle School
Oak Forest Elementary School Humble ISD
Oaks Elementary School
Parkgate Community Church
Pearl Hall Elementary School
Pine Forest Elementary School
Pomeroy Elementary School
Prairie View A&M University Northwest
Red Bluff Elementary School
Reformation Temple Church
Rick Schneider Middle School
River Pines Elementary School
Royce Black Elementary School
Saint Andrews Presbyterian Church
Saint John Lutheran Church and School
Saint Timothy Lutheran Church
Sam Rayburn High School
San Jacinto Community Center
Shadow Forest Elementary School
Sierra Meadows Apartments
SJC South Campus Fine Arts Center Building 15
South Belt Elementary School
Southside Place Park Clubhouse
Stuart Career Tech High School
The Church Without Walls Queenston
The Light of the World Christian Fellowship
Timber Lane Community Center
Timbers Elementary School
Twin Creeks Middle School
University of Houston Clear Lake
W B Travis Elementary School GCCSD
Webster Civic Center
West Campus Gym
West University Place City Hall
Whispering Pines Elementary School
Wildwood Elementary School
Williams Elementary School
Willie B Ermel Elementary School
Willow Creek Elementary School Humble ISD
Windsor Village Community Center
Woodcreek Middle School
* Date of visit to the Poll
* What challenges or discrimination did you encounter voting at the above referenced polling location?
Issues with accessible parking
Issues with getting into the polling place or getting to the voting area (accessibility of polling location)
Issues with accessible voting station or machine
Issues with curbside voting
Issues with obtaining assistance by a person of the voter's choice
Inability to vote independently or privately
Issues with effective communication or auxiliary aids or services
Issues with election judge, election workers, Harris County employees, or other staff
Other
* Please describe these challenges or issues in more detail.
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Please list the names and contact information (phone number, e-mail address, etc.) of any witnesses. If applicable, please also include their relationship to you.
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Did you speak to any election judges, election workers, or employees at the poll about the challenges you encountered? If so, please list their name(s) if you know it (them).
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/2000)
What, if any, accommodations were made to address the challenges you encountered at the polling location?
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What accommodation or changes would you suggest be made at this polling location?
(Characters:
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Do you have any other comments or suggestions related to your voting experience?
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