Chatham County, GA · Chatham County
Title VI Complaint Form
Chatham County complainants can use this form to report alleged discrimination in a county program or activity receiving federal financial assistance.
At a glance
- Issued by
- City of Chatham County · Chatham County, Chatham County, Georgia
- Notarization
- Not required: file this form without a notary.
- Official source
- cccdn.blob.core.windows.net
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This form lets a complainant describe alleged discrimination based on race, color, or national origin and identify the person affected. It asks for contact details, the incident date and account, whether the complaint was filed with another agency or court, and related contact information. Complete and return it to the county Title VI Coordinator; relevant written materials may be attached.
Who needs it
A person alleging discrimination in a covered program or activity can complete this form and provide details about the incident.
How to submit it
Complete and return the form to Mr. Connell Heyward, Title VI Coordinator, Chatham County, 1117 Eisenhower Drive, Suite C, Savannah, GA 31406.
About notarization
This complaint form is signed and dated without a notary; the signer may attach relevant written materials or other information.
How to submit this form
- 1
Download the Form
Download the Chatham County Title VI Complaint Form PDF.
- 2
Complete the Form
Provide your contact details, information about the person affected, the alleged discrimination, and whether you filed elsewhere.
- 3
Gather Relevant Materials
You may attach written materials or other information relevant to your complaint.
- 4
Return the Form
Return it to the Title VI Coordinator at the Chatham County address listed on the form.
Frequently asked questions
- What is the Title VI Complaint Form for?
- It allows a complainant to describe alleged discrimination based on race, color, or national origin and provide details about the incident and the person affected.
- Do I need a notary for the Title VI Complaint Form?
- No. The form has no notary block; the complainant signs and dates it. Relevant written materials or other information may be attached.
- How do I submit the Title VI Complaint Form?
- Complete and return it to Mr. Connell Heyward, Title VI Coordinator, Chatham County, 1117 Eisenhower Drive, Suite C, Savannah, GA 31406.