GHT Form VI Complaints GHT Title VI Complaint Form If you believe that you have been discriminated against because of your race, color, or national origin (including limited English proficiency), by agency programs or activities, you may file a formal complaint. Your Name Please enter name. Email Phone Please enter email or phone. Best time of day to contact you about this complaint: 7am-10am 10am-1pm 1pm-4pm 4pm-7pm Your Mailing Address(Required if response is requested) Street/PO Box City State Zip Person(s) Discriminated against (If other them Complaint) . Name Phone Number City State Zip Discrimination because of Race Color National Origin Date of incident resulting in descriminaton Please provide Information Describe how you were discriminated against. What happened and who was repsonsible ? Please provide Information Did you file this complaint with another federal, state or local agency,or with a federal or state court? Yes No If your answer is Yes,Check each agency that a complaint was filed with Federal Agency Federal Court State Agency State Court Local Agency Other Provide the contact information of the agency you also filled the complaint with. All Above Information are Verified By Me Submit
