Report a Concern
Title VI of the 1964 Civil Rights Act requires that "No person in the United States shall, on the grounds of race, color, sex, age, national origin, or disability be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance."
The requested information will assist us in processing your complaint.
City, State, Zip Code:
Person discriminated against (if someone other than the complainant):
Which of the following best describes the reason you believe the discrimination took place?
Was it because of your:
When did the alleged discrimination take place?
In your own words, describe the alleged discrimination. Explain what happened and whom you believe was responsible.
Have you filed this complaint with any other federal, state, or local agency; or with any federal or state court?
If yes, check all that apply:
Federal agencyFederal court/Federal courtState agency/State agencyState courtLocal agency/Local agency
Please provide information about a contact person at the agency/court where the complaint was filed.
Agency Contact Name:
Attach any written material or other information that you think is relevant to your complaint.