Get Title Vi Complaint Form - Brgrtacomb

This guide provides detailed instructions on how to complete the TITLE VI Complaint Form for Brgrtacomb online. By following these steps, you can ensure that your complaint is submitted accurately and effectively.

Follow the steps to fill out the TITLE VI complaint form:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your personal information in the designated fields. This includes your name, address, home telephone number, work telephone number, and electronic mail address.
3. Indicate any accessible format requirements you may have by selecting from the options: Large Print, Audio Tape, TDD, or Other.
4. Section 2 addresses whether you are filing on your own behalf. If you are filing for someone else, answer accordingly and provide the required details about the third party including their name and relationship to you.
5. Clearly explain why you are filing on behalf of the third party and confirm whether you have their permission to do so.
6. In the next section, indicate the basis of discrimination you experienced by checking all applicable options: Origin, Race, Color, or National.
7. Record the date of the alleged discrimination. Provide a detailed description of what occurred, why you believe discrimination took place, and describe all individuals involved.
8. If possible, provide the name and contact information of the individual(s) accused of discrimination and any witnesses. Additional sheets can be attached if more space is needed.
9. Proceed to Section 4 to specify if you have previously filed a Title VI complaint with this agency or any other agency. Provide details of any additional filings.
10. In Section 6, provide information about the agency the complaint is against, including a contact person, title, and telephone number.
11. You may attach any relevant documents or materials to support your complaint.
12. Finally, sign and date the form as required. Once completed, you can save your changes, download, print, or share the form as needed.

Complete your TITLE VI complaint form online today.