CITY OF MCKINNEY
TITLE VI COMPLAINT FORM
Section I
Name*
Address*
Telephone(Home)* Telephone(Work)*
Email Address*
Accessible Format Requirements? Large_Print* Audio* TDD* Other*
Section II
Are you filing this complaint on your own behalf?*
*If you answered "yes" to this question, go to Section III.
If not, please supply the name and relationship of the person for whom you are complaining:
Please explain why you have filed for a third party:
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):*
Date of Alleged Discrimination(Month, Date, Year):*
Explain as clearly as possible what happened and why you believe you were discriminated against. Describe all persons who were invloved. Include the name and contact information of the person(s) who discriminated against you(if known) as well as names and contact information of any witnesses. If more space is needed, please attach additional pages.
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, or local agency, or with any Federal or State court?*
*If "yes", check all that apply:*
Please provide information about a contact person at the agency/court where the complaint was filed.
Name:*
Title:*
Agency:*
Address:*
Telephone number:*
Section VI
Name of agency complaint is against:*
Contact person:*
Title:*
Telephone number:*
You may attach any written materials or other information that you think is relevant to your complaint(10mb limit)
Acknowledgements*

I have read and understand the following:
Signature
By entering my initials and clicking Submit below, I verify that the information on this form is true and correct, and that I am providing my electronic signature.
Your Initals*
Your IP Address
If you have any further concerns please contact the address shown below, or mail/email this form to :

Shirletta Best, Title VI Coordinator
P.O. Box 517
222 N. Tennessee
McKinney, TX 75070
sbest@mckinneytexas.org

* indicates a required field
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