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Title VI Complaint Procedure

Dawn of Hope operates its programs and services without regard to race, color and national origin in accordance with Title VI of the Civil Rights Act.

If you feel you have been discriminated against, please use the form below to submit your complaint.  You may also use this form to submit a complaint on behalf of another individual.

 

TITLE VI Complaint Form

Section I

Name
Address
Accessible Format Requirements?

Section II

Are you filing this complaint on your own behalf?
(if the answer is yes, please go to Section III)
Please confirm that you have obtained the permission of the aggrieved party if you are filing on behalf of a third party

Section III

I believe the discrimination I experienced was based on (check all that apply)
MM slash DD slash YYYY

Section IV

Have you previously filed a Title VI complaint with this agency?

Section V

Have you filed this complaint with any other Federal, State of local agency, or with any Federal or State court?
If so, please list here.

Please provide information about a contact person at the agency/court where the complaint was filed.

Section VI

Accepted file types: pdf, jpg, doc, Max. file size: 50 MB.

Signature

By typing my name and selecting today's date below, i hereby submit this complaint.

MM slash DD slash YYYY