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Title VI Discrimination Complaint Form Name: Address: City:State:Zip: Phone Number:Alternate Phone Number: Person discriminated against (if someone other than complainant listed above) Name: Address: City:State:Zip: Phone
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How to fill out person discriminated against if

01
Step 1: Start by providing the personal details of the person who has been discriminated against, such as their name, age, and contact information.
02
Step 2: Specify the nature of the discrimination, whether it is based on race, gender, disability, or any other protected characteristic.
03
Step 3: Describe the specific incident(s) where the discrimination took place, providing as much detail as possible, including dates, times, and locations.
04
Step 4: Include any witnesses or evidence that support the claim of discrimination.
05
Step 5: Explain how the discrimination has affected the person, both emotionally and professionally.
06
Step 6: If applicable, mention any previous actions taken to address the discrimination, such as filing a complaint with the appropriate authority.
07
Step 7: Conclude the form by signing and dating it, acknowledging the accuracy of the information provided.
08
Step 8: Keep a copy of the filled-out form for your records.
09
Step 9: Submit the form to the relevant organization or authority responsible for addressing discrimination.

Who needs person discriminated against if?

01
Anyone who has been a target of discrimination based on their race, gender, age, religion, disability, or any other protected characteristic can use the person discriminated against form.
02
This form is useful for individuals who wish to report incidents of discrimination to the appropriate authorities, such as human rights commissions, government agencies, or legal representatives.
03
Additionally, organizations and institutions that are committed to combating discrimination can also make use of this form internally to document and address instances of discrimination within their own structures.
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Person is discriminated against based on their race, gender, age, disability, etc.
Any individual who believes they have been discriminated against.
Fill out the form with details of the discrimination incident and submit it to the appropriate agency.
The purpose is to allow individuals to report instances of discrimination and seek justice or resolution.
Details of the discrimination incident, any witnesses, date/time/location, and any evidence.
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