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AgingNext Title VI ProgramAgingNext Title VI Complaint Form Section I: Please write legibly 1. Name: 2. Address: 3. Telephone:3.a. Secondary Phone (Optional):4. Email Address: 5. Accessible Format
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How to fill out agingnext title vi complaint

01
Start by downloading the AgingNext Title VI Complaint Form from the official AgingNext website.
02
Read the instructions provided on the form thoroughly to understand the process and requirements.
03
Fill out your personal information in the designated sections, including your name, address, phone number, and email.
04
Provide a detailed description of the incident or situation that led to your complaint. Be clear and specific, including any dates, times, locations, and people involved.
05
If there were any witnesses to the incident, list their names, contact information, and a brief statement of what they witnessed.
06
Explain how the incident violated your rights or discriminated against you based on age, race, color, or national origin.
07
State the resolution or outcome you are seeking from filing this complaint.
08
Sign and date the complaint form.
09
Submit your completed complaint form to the designated AgingNext office via mail or email, as mentioned in the instructions.
10
Keep a copy of your complaint form for your records and note the date you submitted it for future reference.

Who needs agingnext title vi complaint?

01
Anyone who believes they have been subjected to discrimination or their rights have been violated based on age, race, color, or national origin when accessing or receiving services from AgingNext can file an AgingNext Title VI Complaint.
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AgingNext Title VI complaint is a formal grievance related to discrimination based on race, color, or national origin in programs or activities funded by the federal government.
Any individual who believes they have been subjected to discrimination or retaliation based on race, color, or national origin in programs or activities funded by the federal government is required to file an AgingNext Title VI complaint.
To fill out an AgingNext Title VI complaint, individuals should contact the appropriate agency or organization overseeing the program or activity in question and request a Title VI complaint form. The form should be completed with detailed information about the alleged discrimination.
The purpose of AgingNext Title VI complaint is to ensure that programs or activities receiving federal funds do not discriminate against individuals based on race, color, or national origin.
An AgingNext Title VI complaint should include details of the alleged discrimination, including dates, times, witnesses, and any relevant documents or evidence.
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