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Title VI Complaint of Discrimination Form


  1. 1. Complainant(s) Information
  2. 2. Agency, Institution, or Department Information
  3. 3. Details
  • Complainant(s) Information

    1. Add Complainant
    2. Add More?
    3. Please add additional complainant(s) names separated by a semi-colon.
    4. Please enter the primary complainant's address
    5. Please provide the phone number of the Primary Complainant.
    6. Please provide the email address of the Primary Complainant.
    7. Please include Name, Address, Phone Number, and Relationship (e.g. friend, attorney, parent, etc.).