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TITLE VI COMPLAINT FORM SECTION 1Name: Address: Phone (Home): Phone (Work): Email Address: Accessible Format Requirements? (circle any that apply) Large Print TDD Audio Tape Other SECTION 2 Are you
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The Title VI complaint form is a document used to report discrimination based on race, color, or national origin in programs or activities that receive federal funding.
Any individual who believes they have been subjected to discrimination based on race, color, or national origin in a federally funded program or activity can file a Title VI complaint.
To fill out the Title VI complaint form, provide personal information such as your name and contact details, describe the facts of the discrimination incident, state the basis for the complaint, and submit it to the appropriate federal agency.
The purpose of the Title VI complaint form is to allow individuals to formally report incidents of discrimination and seek investigation and resolution from federal agencies.
The form typically requires the complainant's contact information, a detailed description of the discriminatory acts, the date and location of the incident, and any relevant witnesses or evidence.
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