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TITLE VI COMPLAINT FORM Section I: Name: Address: Phone (H): Phone (W): Electronic Mail Address: Accessible Format Large Print Requirements? TDD Section II: Are you filing this complaint on your own

How to fill out title vi complaint form

How to fill out a Title VI complaint form?

1. Start by obtaining a copy of the Title VI complaint form. This form is typically available online on the respective organization's website or can be requested from their office.
2. Read the instructions carefully before filling out the form. The instructions will provide you with important information regarding the process and what should be included in your complaint.
3. Begin by providing your personal information. This may include your full name, address, phone number, and email address. Make sure to provide accurate and up-to-date information.
4. Specify the organization or entity against which you are filing the complaint. This will typically include the name of the organization, contact information, and details about the specific program, service, or activity that is subject to your complaint.
5. Clearly state the nature of your complaint. Explain in detail what happened, when it occurred, and who was involved. Be as specific as possible, providing dates, times, and any relevant documentation or evidence that supports your complaint.
6. Describe any attempts you have made to resolve the issue with the organization before filing the complaint. If you have already spoken to someone or submitted a complaint through other channels, include that information in this section.
7. If there were any witnesses to the incident or individuals who may have information relevant to your complaint, provide their names and contact information. This can help support your case and ensure that they are contacted if necessary.
8. Attach any supporting documentation or evidence that you may have. This can include photographs, emails, letters, or any other relevant materials that help illustrate your complaint.
9. Sign and date the complaint form. By signing, you are confirming that the information provided is accurate to the best of your knowledge.

Who needs a Title VI complaint form?

1. Individuals who believe they have experienced discrimination on the basis of race, color, or national origin by a program or activity receiving federal financial assistance may need to fill out a Title VI complaint form.
2. If you have been denied equal access to benefits, services, or opportunities on the grounds of race, color, or national origin, you may need to use a Title VI complaint form to express your concerns.
3. Individuals who have witnessed an act of discrimination and have relevant information might also need to submit a Title VI complaint form to help address the issue.

Note: The specific requirements for filing a Title VI complaint may vary depending on the organization or agency involved. It is advisable to consult the instructions provided with the complaint form or reach out to the relevant organization for guidance in your specific situation.

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