Fitzgerald, GA · Ben Hill County
Title VI Complaint Form
The Title VI Complaint Form lets people report alleged discrimination based on race, color, or national origin to the City of Fitzgerald.
What this form is
Use this form to report alleged discrimination in a program or activity receiving federal financial assistance. It asks for the complainant’s contact details, the person discriminated against if different, the reason and date of the alleged discrimination, and a description of what happened. It also asks whether the complaint was filed elsewhere and requests the complainant’s signature and date.
Who needs it
People who want to submit a Title VI complaint to the City of Fitzgerald can use this form to describe the alleged discrimination.
How to submit it
Complete the form and return it to the City of Fitzgerald, Title VI Complaint Officer/Whitney Justice, at 302 E Central Avenue, Fitzgerald, GA 31750.
About notarization
This form is signed and dated without a notary; supporting materials are optional attachments, and no sworn step is stated.
How to submit this form
- 1
Download The Form
Download the City of Fitzgerald Title VI Complaint Form.
- 2
Complete The Form
Provide your contact details and describe the alleged discrimination, including its reason and date.
- 3
Gather Supporting Materials
Attach any written materials or other information you think is relevant to your complaint.
- 4
Sign And Submit
Sign and date the form, then return it to the named complaint officer at the address on the form.
Frequently asked questions
- What is the Title VI Complaint Form for?
- Use it to report alleged discrimination in a program or activity receiving federal financial assistance. The form asks about the reason, date, and circumstances of the alleged discrimination.
- Who can file this form?
- A person who wants to report alleged discrimination to the City of Fitzgerald can complete the form. It also provides space for information about the person discriminated against if that person is someone other than the complainant.
- How do I submit the Title VI Complaint Form?
- Complete and return it to the City of Fitzgerald, Title VI Complaint Officer/Whitney Justice, at 302 E Central Avenue, Fitzgerald, GA 31750.
- Do I need a notary for the Title VI Complaint Form?
- No. The form asks the complainant to sign and date it without a notary. Supporting written materials or other relevant information may be attached, but no sworn step is stated.
Need something notarized?
This Title VI Complaint Form doesn’t need a notary — but if you have another Fitzgerald form that does, a commissioned online notary can help.