GHT Form VI Complaints

GHT Form VI complaints

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

Phone

Best time of day to contact you about this complaint: 7am-10am 10am-1pm 1pm-4pm 4pm-7pm

Your Mailing Address

Street/PO Box

City

State

Zip

Person(s) who is alleged to have discriminated against you.

Name

Phone Number

City

State

Zip

Discrimination because of

Please explain what happened, why you believe it happened, and how you were discriminated against. Indicate who was involved. Be sure to include how you feel other persons were treated differently than you. If you have any other information about what happened, please attach supporting documents to this form.

What remedy are you seeking for the alleged discrimination? Please note that this process will not result in the payment of punitive damages or financial compensation.

List any other persons that we should contact for additional information in support of your complaint. Please include their phone numbers, addresses, email addresses, etc.

List any other agencies with whom you have filed this same complaint:

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