Atwater, CA · Merced County
Title VI Complaint Form
Atwater residents who believe they experienced discrimination in a city program, service, or activity can use this form to file a complaint.
What this form is
This form allows a person who believes they experienced discrimination in a City of Atwater program, service, or activity to file a complaint. It asks for contact details, information about the person affected and witnesses, the reason for the complaint, and a narrative describing events and requested corrective action. The city requires complaints to be received within 90 days of the discrimination.
Who needs it
A person who believes they experienced discrimination in a City of Atwater program, service, or activity can file this complaint.
How to submit it
Mail the completed form and any supporting documents to the Human Resources Director, City of Atwater, 1160 Fifth Street, Atwater, CA 95301.
About notarization
This complaint form is signed and dated without a notary; supporting documents may be attached, but the form does not require them to be notarized.
How to submit this form
- 1
Download the Form
Download the Title VI Complaint Form to begin filing a complaint.
- 2
Complete the Form
Provide your contact details, information about the person affected and witnesses, the reason for the complaint, and a narrative of events.
- 3
Gather Supporting Documents
Attach any documents you have that support the complaint. The form says additional sheets may be added.
- 4
Mail the Complaint
Mail the signed and dated form and supporting documents to the Human Resources Director at the address listed on the form.
Frequently asked questions
- Do I need a notary for the Title VI Complaint Form?
- No. Sign and date the complaint form without a notary. Supporting documents may be attached, but the form does not require them to be notarized.
- How do I submit the Title VI Complaint Form?
- Mail the completed form and any supporting documents to the Human Resources Director, City of Atwater, 1160 Fifth Street, Atwater, CA 95301.
- When must the city receive a Title VI complaint?
- The form states that all complaints must be received within 90 days of the discrimination.
- What information does the complaint form request?
- It asks for contact information, details about the person affected and witnesses, the reason for the complaint, and a narrative with the corrective action requested.