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MONROE SCHOOL DISTRICT #1JCODE: AC/Form APPROVED: 03/13/06 REVISED: 8/13/18 REVIEWED:Discrimination Complaint Form Name of Person Filing Complaint: Date School or Activity G Student/Parent G Employee

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What is ac aca-f discrimination complaint?

ac aca-f discrimination complaint is a complaint filed under the Affordable Care Act (ACA) alleging discrimination based on race, color, national origin, sex, age, or disability in a health program or activity.

Who is required to file ac aca-f discrimination complaint?

Any individual who believes they have been discriminated against in a health program or activity covered by the ACA is required to file an ac aca-f discrimination complaint.

How to fill out ac aca-f discrimination complaint?

To fill out an ac aca-f discrimination complaint, one must provide their personal information, details of the alleged discrimination, and any supporting documents or evidence.

What is the purpose of ac aca-f discrimination complaint?

The purpose of an ac aca-f discrimination complaint is to address and investigate allegations of discrimination in health programs or activities covered by the ACA.

What information must be reported on ac aca-f discrimination complaint?

Information such as the nature of the discrimination, date and location of the incident, names of individuals involved, and any relevant documentation should be reported on an ac aca-f discrimination complaint.

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