General, ADA & Title VI Non-discrimination Complaint Form

GENERAL, ADA & TITLE VI NON-DISCRIMINATION COMPLAINT FORM
Check what you believe to be the basis for the discrimination against you. Check all that apply. *
Have you filed a complaint with any other agency? *
(Explain what happened, the date(s) incidents occurred, who was involved etc.)
Address *
Address
City
State/Province
Zip/Postal

All complaints need to be filed within 180 days of the last occurrence of discrimination and/or harassment.